Provider Demographics
NPI:1750499380
Name:VINCENT GALIANO M D P A
Entity Type:Organization
Organization Name:VINCENT GALIANO M D P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:MASTERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-737-6313
Mailing Address - Street 1:8031 PHILIPS HWY
Mailing Address - Street 2:#6
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-4451
Mailing Address - Country:US
Mailing Address - Phone:904-737-6313
Mailing Address - Fax:904-739-1302
Practice Address - Street 1:8031 PHILIPS HWY
Practice Address - Street 2:#6
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-4451
Practice Address - Country:US
Practice Address - Phone:904-737-6313
Practice Address - Fax:904-739-1302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME78889207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK6845Medicare PIN