| Gaines C Martin Md Phd Pa | |
|
1409 Kingsley Ave Ste 9g Orange Park FL 32073-4579 | |
| (904) 637-0007 | |
| Not Available |
| Full Name | Gaines C Martin Md Phd Pa |
|---|---|
| Speciality | Family Medicine |
| Location | 1409 Kingsley Ave Ste 9g, Orange Park, Florida |
| Authorized Official Name and Position | Gaines Charles Martin (OWNER) |
| Authorized Official Contact | 9046370007 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Gaines C Martin Md Phd Pa 1409 Kingsley Ave Ste 9g Orange Park FL 32073-4579 Ph: (904) 637-0007 | Gaines C Martin Md Phd Pa 1409 Kingsley Ave Ste 9g Orange Park FL 32073-4579 Ph: (904) 637-0007 |
| NPI Number | 1265627541 |
|---|---|
| Provider Enumeration Date | 09/11/2007 |
| Last Update Date | 04/08/2020 |
| Medicare PECOS PAC ID | 8820184997 |
|---|---|
| Medicare Enrollment ID | O20071020000003 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265627541 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Gaines C Martin |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1639103021 PECOS PAC ID: 7911093083 Enrollment ID: I20071020000001 |
| Provider Name | Marylou V Ello |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1861642753 PECOS PAC ID: 0840350799 Enrollment ID: I20081121000270 |
| Provider Name | Gaston Metelus |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1235638602 PECOS PAC ID: 3274862172 Enrollment ID: I20190830002238 |
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