Individual
EDDIE LEON GAINES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
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
Update your record
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