Provider Demographics
NPI:1598746612
Name:GALAN, JORGE L (DO)
Entity Type:Individual
Prefix:
First Name:JORGE
Middle Name:L
Last Name:GALAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2739 LAUREL ST STE 1A
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29204-2028
Mailing Address - Country:US
Mailing Address - Phone:803-799-4800
Mailing Address - Fax:803-252-0052
Practice Address - Street 1:2739 LAUREL ST STE 1A
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29204-2028
Practice Address - Country:US
Practice Address - Phone:803-779-4800
Practice Address - Fax:803-252-0052
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC00561207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCT00567Medicaid
SCP01077727OtherMEDICARE RAILROAD
SCP01077727OtherMEDICARE RAILROAD
SCT00567Medicaid
SCG90671Medicare UPIN