Healthcare Provider Details

I. General information

NPI: 1053688515
Provider Name (Legal Business Name): GAINES PLASTIC SURGERY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2011
Last Update Date: 11/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 NW 76TH DR SUITE A
GAINESVILLE FL
32607-6652
US

IV. Provider business mailing address

108 NW 76TH DR SUITE A
GAINESVILLE FL
32607-6652
US

V. Phone/Fax

Practice location:
  • Phone: 352-333-9600
  • Fax: 352-333-9606
Mailing address:
  • Phone: 352-333-9600
  • Fax: 352-333-9606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberME76402
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberME76402
License Number StateFL

VIII. Authorized Official

Name: DR. GREGORY C. GAINES
Title or Position: OWNER
Credential: MD, FACS
Phone: 352-333-9600