Provider Demographics
NPI:1295266427
Name:GALICIAN, JORDAN SCOTT (MD)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:SCOTT
Last Name:GALICIAN
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 1:1000 36TH ST
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-4862
Mailing Address - Country:US
Mailing Address - Phone:772-794-3364
Mailing Address - Fax:772-794-3366
Practice Address - Street 1:3450 11TH CT STE 201
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-5012
Practice Address - Country:US
Practice Address - Phone:772-794-3364
Practice Address - Fax:772-794-3366
Is Sole Proprietor?:No
Enumeration Date:2017-03-21
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME165146207Q00000X
WAML61107522390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine