Individual
MATTHEW GAINES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
4301 WILSON ST, FORT SILL, OK 73503-4472
(580) 558-8272
Mailing address
4301 WILSON ST, FORT SILL, OK 73503-4472
(580) 558-8272
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
4811
OK
Other
Enumeration date
08/09/2020
Last updated
12/27/2023
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