Healthcare Provider Details

I. General information

NPI: 1780707299
Provider Name (Legal Business Name): GREGORY CYRUS GAINES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 09/14/2016
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 TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License NumberME76402
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: