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Individual

EDDIE LEON GAINES

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
42145 N FAIRGREEN CT, ANTHEM, AZ 85086-1066
(575) 405-7697
Mailing address
3800 E LOHMAN AVE, LAS CRUCES, NM 88011-8273
(575) 522-6500
(575) 522-0591

Taxonomy

Speciality
Code
Description
License number
State
207KA0200X
Allergy Physician
Primary
94250
NM
208D00000X
General Practice Physician
94250
NM

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
26189
NM
Enumeration date
05/04/2006
Last updated
03/27/2019
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