Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 020590 | LA |
NPI | 1023123114 |
---|---|
Provider Name | Dr. Camalyn Woodard Gaines |
First Address | La Place, LA 70068-1617 |
Second Address | Baton Rouge, LA 70809-7439 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/08/2006 |
Last Update Date | 08/07/2007 |