Individual
DR. GAINES CHARLES MARTIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1409 KINGSLEY AVE, SUITE 9G, ORANGE PARK, FL 32073
(904) 637-0007
(866) 482-9906
Mailing address
1409 KINGSLEY AVE, SUITE 9G, ORANGE PARK, FL 32073
(904) 637-0007
(866) 482-9906
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
ME81545
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
266202700
—
FL
01
—
2687947
AETNA HMO
—
01
—
279755
AVMED
—
01
—
51002
BCBS MEDICARE
—
05
—
59-3720215
—
FL
Enumeration date
07/10/2006
Last updated
03/15/2013
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