Provider Demographics
NPI:1710948815
Name:GAINES, ROBERT (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:GAINES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3420 22ND PL
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79410-1314
Mailing Address - Country:US
Mailing Address - Phone:806-725-5844
Mailing Address - Fax:806-723-6532
Practice Address - Street 1:3506 21ST ST STE 203
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79410-1211
Practice Address - Country:US
Practice Address - Phone:806-725-4805
Practice Address - Fax:806-723-7076
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2014-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101232423207X00000X
TXF4038207XX0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0801XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Trauma
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL278542100Medicaid
NM44670320Medicaid
FL310441OtherAVMED
TX325041701Medicaid
TX8DV968OtherBCBS TX
TX950008100OtherFIRSTCARE
TXP01228218OtherRAILROAD MEDICARE
FL96135OtherBC/BS
TXP01228218OtherRAILROAD MEDICARE
TX299405YKT8Medicare PIN