Provider Demographics
NPI:1336267392
Name:CAIN, GARY E (PA-C)
Entity type:Individual
Prefix:MR
First Name:GARY
Middle Name:E
Last Name:CAIN
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 746638
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-6638
Mailing Address - Country:US
Mailing Address - Phone:904-202-2092
Mailing Address - Fax:904-376-4075
Practice Address - Street 1:1008 PARK AVE STE A
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-4112
Practice Address - Country:US
Practice Address - Phone:904-264-9293
Practice Address - Fax:904-390-7492
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPA3276363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00773426OtherRR MEDICARE
FLP334560001Medicare UPIN
FLP00773426OtherRR MEDICARE