1477006575 NPI number — MR. JED OLIVER GALASSO PA-C

Table of content: DR. RONALD E. COLEMAN PH.D. (NPI 1528192770)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477006575 NPI number — MR. JED OLIVER GALASSO PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GALASSO
Provider First Name:
JED
Provider Middle Name:
OLIVER
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1477006575
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/08/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 112727
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GAINESVILLE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32611-2727
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
352-273-7002
Provider Business Mailing Address Fax Number:
352-273-7388

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
145 CITY PL STE 201
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PALM COAST
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32164-2480
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-819-2999
Provider Business Practice Location Address Fax Number:
904-819-8299
Provider Enumeration Date:
07/26/2016

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363A00000X , with the licence number:  PA9109644 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)