1457460578 NPI number — JOHN DAVID SINCLAIR MD

Table of content: JOHN DAVID SINCLAIR MD (NPI 1457460578)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457460578 NPI number — JOHN DAVID SINCLAIR MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SINCLAIR
Provider First Name:
JOHN
Provider Middle Name:
DAVID
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SINCLAIR
Provider Other First Name:
J
Provider Other Middle Name:
DAVID
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1457460578
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/04/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3130 E MADISON ST
Provider Second Line Business Mailing Address:
SUITE 205
Provider Business Mailing Address City Name:
SEATTLE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98112-4264
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-329-2393
Provider Business Mailing Address Fax Number:
206-329-9614

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
155 NE 100TH ST
Provider Second Line Business Practice Location Address:
STE 402
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98125-8012
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-729-4300
Provider Business Practice Location Address Fax Number:
206-275-3695
Provider Enumeration Date:
08/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208VP0000X , with the licence number:  MD00034862 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0133008 . This is a "L&I" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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