Provider Demographics
NPI:1487627873
Name:CASEY N GAINES MD PA
Entity Type:Organization
Organization Name:CASEY N GAINES MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CASEY
Authorized Official - Middle Name:
Authorized Official - Last Name:GAINES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-867-2373
Mailing Address - Street 1:1761 OCEANVIEW DR
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33715-2509
Mailing Address - Country:US
Mailing Address - Phone:727-867-2373
Mailing Address - Fax:
Practice Address - Street 1:1761 OCEANVIEW DR
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33715-2509
Practice Address - Country:US
Practice Address - Phone:727-867-2373
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-08
Last Update Date:2011-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME42122207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL067463000Medicaid
62423OtherBCBS
K7009Medicare ID - Type Unspecified
D57449Medicare UPIN