Provider Demographics
NPI:1730103599
Name:GAINES, CASADY BLAUW (MD)
Entity Type:Individual
Prefix:DR
First Name:CASADY
Middle Name:BLAUW
Last Name:GAINES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:FL
Mailing Address - Zip Code:32696-2136
Mailing Address - Country:US
Mailing Address - Phone:352-529-0477
Mailing Address - Fax:352-529-0406
Practice Address - Street 1:223 N MAIN ST
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:FL
Practice Address - Zip Code:32696-2136
Practice Address - Country:US
Practice Address - Phone:352-529-0477
Practice Address - Fax:352-529-0406
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2011-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME80631208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL275068600Medicaid
FL275068600Medicaid