Basic Information
| Provider Information | |||||||||
| NPI: | 1700995479 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GLOBAL FAMILY MEDICINE, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14 OAK FOREST RD | ||||||||
| Address2: | SUITE D | ||||||||
| City: | BLUFFTON | ||||||||
| State: | SC | ||||||||
| PostalCode: | 299104988 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8438156468 | ||||||||
| FaxNumber: | 8348156492 | ||||||||
| Practice Location | |||||||||
| Address1: | 14 OAK FOREST RD | ||||||||
| Address2: | STE D | ||||||||
| City: | BLUFFTON | ||||||||
| State: | SC | ||||||||
| PostalCode: | 299104988 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8438156468 | ||||||||
| FaxNumber: | 8348156492 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/29/2006 | ||||||||
| LastUpdateDate: | 05/24/2012 | ||||||||
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| AuthorizedOfficialLastName: | PEREZ | ||||||||
| AuthorizedOfficialFirstName: | GASTON | ||||||||
| AuthorizedOfficialMiddleName: | O. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8438156468 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. F.A.A.F.P. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 17810 | SC | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 178104 | 05 | SC | MEDICAID | 7123 | 01 | SC | MEDICARE PTAN | OTHER |