MEDICARE: MR. JED OLIVER GALASSO PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA9109644	FL

General Provider Information

NPI Number	:	1477006575
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JED OLIVER GALASSO PA-C

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

Provider Business Practice Location Address
First Line	:	145 CITY PL STE 201
Second Line	:
City	:	PALM COAST
State	:	FL
Zip	:	32164-2480
Country	:	US
Telephone Number	:	904-819-2999
Fax Number	:	904-819-8299

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/26/2016
Last Update Date	:	04/08/2025

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