Provider Demographics
NPI:1982027801
Name:GAINES, CHARLES SR
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:
Last Name:GAINES
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15518 SW 36 TR
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33185
Mailing Address - Country:US
Mailing Address - Phone:786-299-5922
Mailing Address - Fax:
Practice Address - Street 1:15518 SW 36TH TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33185-4811
Practice Address - Country:US
Practice Address - Phone:786-299-5922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-29
Last Update Date:2014-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant