Provider Demographics
NPI:1730161423
Name:GAINES, SHERI C (MD)
Entity type:Individual
Prefix:
First Name:SHERI
Middle Name:C
Last Name:GAINES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 545
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:77342-0545
Mailing Address - Country:US
Mailing Address - Phone:281-530-5600
Mailing Address - Fax:936-438-8527
Practice Address - Street 1:284 INTERSTATE 45 S STE 1
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:TX
Practice Address - Zip Code:77340-4967
Practice Address - Country:US
Practice Address - Phone:936-438-8200
Practice Address - Fax:936-438-8527
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-17
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH99372084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00R12XOtherBLUE CROSS
TX123805702Medicaid
TX260049562OtherRAILROAD MEDICARE
TX8AJ820OtherBLUE CROSS
TX123805702Medicaid