Healthcare Provider Details

I. General information

NPI: 1679731574
Provider Name (Legal Business Name): THOMAS GRIFFIN GAINES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2008
Last Update Date: 04/20/2021
Certification Date: 04/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3530 HOUMA BLVD STE 300
METAIRIE LA
70006-4203
US

IV. Provider business mailing address

3100 GENTILLY BLVD
NEW ORLEANS LA
70122-3854
US

V. Phone/Fax

Practice location:
  • Phone: 504-264-5142
  • Fax:
Mailing address:
  • Phone: 504-383-0599
  • Fax: 504-383-0594

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD.204325
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME127642
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberME127642
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberME127642
License Number StateFL
# 5
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberMD.204325
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: