Healthcare Provider Details

I. General information

NPI: 1881619476
Provider Name (Legal Business Name): IRA L GAINES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 11/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11001 DURANT RD SUITE 100
RALEIGH NC
27614-8390
US

IV. Provider business mailing address

11001 DURANT RD SUITE 100
RALEIGH NC
27614-8390
US

V. Phone/Fax

Practice location:
  • Phone: 919-781-2500
  • Fax: 919-781-9247
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number38767
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: