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NPI Code Detail

MEDICARE: EUGENE B SINCLAIR JR. ATC

MEDICARE: EUGENE B SINCLAIR JR. ATC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12255A2300XAthletic Trainer6320FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12000042566OTHERFLBOARD OF CERTIFICATION
26320OTHERFLATHLETIC TRAINING LINCESURE

General Provider Information

NPI Number : 1730859109
Entity Type Code : Individual
Provider Name (Legal Business Name) : EUGENE B SINCLAIR JR. ATC
Provider Business Mailing Address
First Line : 3978 75TH ST W APT 405
Second Line :
City : BRADENTON
State : FL
Zip : 34209-5810
Country : US
Telephone Number : 904-554-8536
Fax Number :
Provider Business Practice Location Address
First Line : 5650 BOLLETTIERI BLVD
Second Line :
City : BRADENTON
State : FL
Zip : 34210-2211
Country : US
Telephone Number : 800-872-6425
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/16/2021
Last Update Date : 09/16/2021

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