Individual
BEVERLY M GAINES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
305 W BROADWAY, SUITE 104, LOUISVILLE, KY 40202-2129
(502) 585-2924
(502) 585-2931
Mailing address
305 W BROADWAY, SUITE 104, LOUISVILLE, KY 40202-2129
(502) 585-2924
(502) 585-2931
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
20974
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
64209745
—
KY
Enumeration date
10/17/2006
Last updated
12/28/2012
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