Provider Demographics
NPI:1336651710
Name:GLOBAL FAMILY PRACTICE, PLLC
Entity Type:Organization
Organization Name:GLOBAL FAMILY PRACTICE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY PHYSICIAN, MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:SHIVUM
Authorized Official - Middle Name:
Authorized Official - Last Name:AGARWAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:940-247-2579
Mailing Address - Street 1:PO BOX 444
Mailing Address - Street 2:
Mailing Address - City:JACKSBORO
Mailing Address - State:TX
Mailing Address - Zip Code:76458-0444
Mailing Address - Country:US
Mailing Address - Phone:940-217-5969
Mailing Address - Fax:
Practice Address - Street 1:215 CHISHOLM TRL
Practice Address - Street 2:
Practice Address - City:JACKSBORO
Practice Address - State:TX
Practice Address - Zip Code:76458-1403
Practice Address - Country:US
Practice Address - Phone:940-217-5969
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-25
Last Update Date:2018-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty