Healthcare Provider Details

I. General information

NPI: 1417349580
Provider Name (Legal Business Name): JASMINE P GAINES M.D., PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2015
Last Update Date: 07/21/2020
Certification Date: 07/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 S UNIVERSITY BLVD STE D
MOBILE AL
36609-2949
US

IV. Provider business mailing address

1542 TULANE AVE BOX T4M-2
NEW ORLEANS LA
70112-2865
US

V. Phone/Fax

Practice location:
  • Phone: 251-344-1964
  • Fax: 251-344-2227
Mailing address:
  • Phone: 504-568-3792
  • Fax: 504-568-2127

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number34737
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number34737
License Number StateAL
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34737
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: