Healthcare Provider Details

I. General information

NPI: 1801598461
Provider Name (Legal Business Name): DONALD LEE GAINES III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2023
Last Update Date: 05/25/2025
Certification Date: 05/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 CRAG RD
PANAMA CITY BEACH FL
32407-7013
US

IV. Provider business mailing address

US FLEET FORCES COMMAND HEALTH SVCS 1562 MITSCHER AVE
NORFOLK VA
23551-0001
US

V. Phone/Fax

Practice location:
  • Phone: 850-235-5218
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: