MEDICARE: ORNETTE L GAINES M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	E-4274	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	05070027700	OTHER	AR	QUAL CHOICE
3	5N255	OTHER	AR	BCBS

General Provider Information

NPI Number	:	1386613503
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ORNETTE L GAINES M.D.

Provider Business Mailing Address
First Line	:	614 E EMMA AVE
Second Line	:	SUITE 300
City	:	SPRINGDALE
State	:	AR
Zip	:	72764-4634
Country	:	US
Telephone Number	:	479-751-7417
Fax Number	:	479-751-4898

Provider Business Practice Location Address
First Line	:	1233 W POPLAR ST
Second Line	:
City	:	ROGERS
State	:	AR
Zip	:	72756-4245
Country	:	US
Telephone Number	:	479-751-7417
Fax Number	:	479-751-4898

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/17/2006
Last Update Date	:	11/10/2011

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Directions to “ ORNETTE L GAINES M.D.” Practice Location

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