Healthcare Provider Details

I. General information

NPI: 1720522964
Provider Name (Legal Business Name): GABRIEL P. GALAN DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: GABRIEL P. GALAN DPM

II. Dates (important events)

Enumeration Date: 12/07/2016
Last Update Date: 07/28/2025
Certification Date: 07/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 GROOVER LOOP STE 201
ST AUGUSTINE FL
32086-6586
US

IV. Provider business mailing address

6800 SOUTHPOINT PKWY STE 300
JACKSONVILLE FL
32216-8203
US

V. Phone/Fax

Practice location:
  • Phone: 904-634-0640
  • Fax: 904-634-0203
Mailing address:
  • Phone: 904-634-0640
  • Fax: 904-634-0203

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPO4017
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: