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General NPI Number Information
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NPI Number | 1477006575
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Entity Type | Individual
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Provider Name | JED OLIVER GALASSO PA-C
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Gender | Male
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Dates
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Enumeration Date | 07/26/2016
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Last Update Date | 04/08/2025
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Provider Practice Location Address
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Address Line | 145 CITY PL STE 201
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City | PALM COAST
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State | FL
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Zip | 32164-2480
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Country | US
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Telephone | 904-819-2999
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Fax | 904-819-8299
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Provider Business Mailing Address
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Address Line | PO BOX 112727
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City | GAINESVILLE
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State | FL
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Zip | 32611-2727
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Country | US
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Telephone | 352-273-7002
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Fax | 352-273-7388
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA9109644
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License Number State | FL
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