Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RP1001X | Pulmonary Disease | 17367 | AL |
NPI | 1013901594 |
---|---|
Provider Name | Brian Reynolds Sinclair |
First Address | Dothan, AL 36302-2266 |
Second Address | Dothan, AL 36301-4770 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/09/2005 |
Last Update Date | 17/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000045920 | (05) | AL |
00553308C | (05) | GA |
373174000 | (05) | FL |
F57252 | (02) | AL |