Provider Demographics
NPI:1700995479
Name:GLOBAL FAMILY MEDICINE, LLC
Entity Type:Organization
Organization Name:GLOBAL FAMILY MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GASTON
Authorized Official - Middle Name:O
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD FAAFP
Authorized Official - Phone:843-815-6468
Mailing Address - Street 1:14 OAK FOREST RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29910-4988
Mailing Address - Country:US
Mailing Address - Phone:843-815-6468
Mailing Address - Fax:834-815-6492
Practice Address - Street 1:14 OAK FOREST RD
Practice Address - Street 2:STE D
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910-4988
Practice Address - Country:US
Practice Address - Phone:843-815-6468
Practice Address - Fax:834-815-6492
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2012-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC17810207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC178104Medicaid
SC7123OtherMEDICARE PTAN
SC7123OtherMEDICARE PTAN
F90897Medicare UPIN