Provider Demographics
NPI:1770607145
Name:KAIN, GIDEON ALLEN (IDC)
Entity type:Individual
Prefix:MR
First Name:GIDEON
Middle Name:ALLEN
Last Name:KAIN
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8301 SALSA DR
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78414-6452
Mailing Address - Country:US
Mailing Address - Phone:619-988-5246
Mailing Address - Fax:
Practice Address - Street 1:10651 E ST.
Practice Address - Street 2:NAVAL HEALTH CLINIC CORPUS CHRISTI
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78419
Practice Address - Country:US
Practice Address - Phone:619-988-5246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman