Provider Demographics
NPI:1174539068
Name:GAINES, TAY GARNETT (MD)
Entity type:Individual
Prefix:DR
First Name:TAY
Middle Name:GARNETT
Last Name:GAINES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1914 37TH ST
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33407-3506
Mailing Address - Country:US
Mailing Address - Phone:561-845-0974
Mailing Address - Fax:561-840-6525
Practice Address - Street 1:1914 37TH ST
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407-3506
Practice Address - Country:US
Practice Address - Phone:561-845-0974
Practice Address - Fax:561-840-6525
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2008-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME557072084P0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL09812WOtherMEDICARE PTAN