Provider Demographics
NPI:1417349580
Name:GAINES, JASMINE P (MD, PHD)
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:P
Last Name:GAINES
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1542 TULANE AVE
Mailing Address - Street 2:BOX T4M-2
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70112-2865
Mailing Address - Country:US
Mailing Address - Phone:504-568-3792
Mailing Address - Fax:504-568-2127
Practice Address - Street 1:801 S UNIVERSITY BLVD STE D
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36609-2949
Practice Address - Country:US
Practice Address - Phone:251-344-1964
Practice Address - Fax:251-344-2227
Is Sole Proprietor?:No
Enumeration Date:2015-02-26
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL34737207R00000X, 208000000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics