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General NPI Number Information
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NPI Number | 1942444757
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Entity Type | Organization
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Legal Business Name | DR JARED GAINES MD PA
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Dates
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Enumeration Date | 04/23/2009
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Last Update Date | 11/25/2009
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Provider Practice Location Address
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Address Line | 1555 KINGSLEY AVE BLDG 300 SUITE 305
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City | ORANGE PARK
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State | FL
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Zip | 32073-4560
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Country | US
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Telephone | 352-284-4216
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Fax | 866-681-5094
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Provider Business Mailing Address
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Address Line | 1555 KINGSLEY AVE BLDG 300 SUITE 305
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City | ORANGE PARK
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State | FL
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Zip | 32073-4560
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Country | US
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Telephone | 352-284-4216
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Fax | 866-681-5094
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Authorized Official
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Title or Position | OWNER
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Name | JARED B GAINES
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Credential | MD
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Telephone | 352-284-4216
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number |
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License Number State |
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