Provider Demographics
NPI:1689814048
Name:GALLEON, ANAS FARAG (MD)
Entity Type:Individual
Prefix:
First Name:ANAS
Middle Name:FARAG
Last Name:GALLEON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 409992
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-9992
Mailing Address - Country:US
Mailing Address - Phone:904-697-3610
Mailing Address - Fax:904-697-5890
Practice Address - Street 1:6535 NEMOURS PARKWAY
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32827-7884
Practice Address - Country:US
Practice Address - Phone:407-567-4000
Practice Address - Fax:407-567-5924
Is Sole Proprietor?:No
Enumeration Date:2009-02-25
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP60003(LTD PERMIT)208000000X
KS04-342662080P0203X
FLME1254942080P0203X
NC2015-000452080P0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL015982900Medicaid