Individual
DR. LISA SUZANNE GAINES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
205 E PALMER RD, BELLEFONTAINE, OH 43311
(937) 592-4015
Mailing address
205 E PALMER RD, BELLEFONTAINE, OH 43311-2281
(937) 592-4015
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
34-007655
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2338438
—
OH
Enumeration date
01/19/2006
Last updated
01/10/2019
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