# GAINES C MARTIN MD PHD PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1265627541
- **Authorized official:** GAINES CHARLES MARTIN (OWNER)
- **Authorized official phone:** (904) 637-0007

## Contact information

- **Practice address:** 1409 KINGSLEY AVE STE 9G, ORANGE PARK, FL 32073-4579
- **Practice address phone:** (904) 637-0007
- **Mailing address:** 1409 KINGSLEY AVE STE 9G, ORANGE PARK, FL 32073-4579
- **Mailing address phone:** (904) 637-0007

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 09/11/2007
- **Last updated:** 04/08/2020