Provider Demographics
NPI:1386613503
Name:GAINES, ORNETTE L (MD)
Entity type:Individual
Prefix:
First Name:ORNETTE
Middle Name:L
Last Name:GAINES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:614 E EMMA AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72764-4634
Mailing Address - Country:US
Mailing Address - Phone:479-751-7417
Mailing Address - Fax:479-751-4898
Practice Address - Street 1:1233 W POPLAR ST
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72756-4245
Practice Address - Country:US
Practice Address - Phone:479-751-7417
Practice Address - Fax:479-751-4898
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ARE-4274207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR158174001Medicaid
AR05070027700OtherQUAL CHOICE
AR5N255OtherBCBS
AR05070027700OtherQUAL CHOICE
AR5N255OtherBCBS