Individual
DR. CAROL M GAINES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
5535 S. WILLIAMSON BLVD, SUITE 700, PORT ORANGE, FL 32128-8311
(386) 231-6300
(386) 322-6165
Mailing address
5535 S WILLIAMSON BLVD, SUITE 700, PORT ORANGE, FL 32128-8311
(740) 707-1647
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
OS10126
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
08CBCLW
MEDICARE
GA
05
—
489023752B
—
GA
Enumeration date
01/02/2006
Last updated
01/04/2017
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