Provider Demographics
NPI:1477759884
Name:GAINES, RICHARD KENNETH (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:KENNETH
Last Name:GAINES
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3389 SHERIDAN ST
Mailing Address - Street 2:#439
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-3606
Mailing Address - Country:US
Mailing Address - Phone:954-962-5888
Mailing Address - Fax:954-961-2433
Practice Address - Street 1:2699 STIRLING RD
Practice Address - Street 2:SUITE C-201
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33312
Practice Address - Country:US
Practice Address - Phone:877-939-4246
Practice Address - Fax:877-939-4248
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-22
Last Update Date:2011-11-08
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Provider Licenses
StateLicense IDTaxonomies
FLME466412083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine