Provider Demographics
NPI:1427176395
Name:GAIN, OSCAR RAYNOMD JR (PT)
Entity type:Individual
Prefix:MR
First Name:OSCAR
Middle Name:RAYNOMD
Last Name:GAIN
Suffix:JR
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1105 FOREST HILL DR
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62221-4008
Mailing Address - Country:US
Mailing Address - Phone:618-235-2639
Mailing Address - Fax:618-235-2639
Practice Address - Street 1:1105 FOREST HILL DR
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62221-4008
Practice Address - Country:US
Practice Address - Phone:618-235-2639
Practice Address - Fax:618-235-2639
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital