Provider Demographics
NPI:1235117102
Name:GAINES, CAROL M (DO)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:M
Last Name:GAINES
Suffix:
Gender:F
Credentials:DO
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Mailing Address - Street 1:5535 S WILLIAMSON BLVD
Mailing Address - Street 2:SUITE 700
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32128-8311
Mailing Address - Country:US
Mailing Address - Phone:740-707-1647
Mailing Address - Fax:
Practice Address - Street 1:5535 S. WILLIAMSON BLVD
Practice Address - Street 2:SUITE 700
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32128-8311
Practice Address - Country:US
Practice Address - Phone:386-231-6300
Practice Address - Fax:386-322-6165
Is Sole Proprietor?:No
Enumeration Date:2006-01-02
Last Update Date:2017-01-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLOS10126207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA08CBCLWOtherMEDICARE
GA489023752BMedicaid
GA08CBCLWOtherMEDICARE