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General NPI Number Information
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NPI Number | 1235117102
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Entity Type | Individual
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Provider Name | CAROL M GAINES DO
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Gender | Female
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Dates
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Enumeration Date | 01/02/2006
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Last Update Date | 01/04/2017
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Provider Practice Location Address
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Address Line | 5535 S. WILLIAMSON BLVD SUITE 700
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City | PORT ORANGE
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State | FL
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Zip | 32128-8311
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Country | US
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Telephone | 386-231-6300
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Fax | 386-322-6165
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Provider Business Mailing Address
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Address Line | 5535 S WILLIAMSON BLVD SUITE 700
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City | PORT ORANGE
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State | FL
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Zip | 32128-8311
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Country | US
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Telephone | 740-707-1647
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | OS10126
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License Number State | FL
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