Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204F00000X | Transplant Surgeon | A56109 | CA |
Y | 204F00000X | Transplant Surgeon | J0883 | TX |
NPI | 1326072604 |
---|---|
Provider Name | Dr. Rafik Mark Ghobrial M.d. |
First Address | Houston, TX 77030-2717 |
Second Address | Houston, TX 77030-2717 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2006 |
Last Update Date | 10/01/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A561090 | (05) | CA |
104048704 | (05) | TX |
104048705 | (05) | TX |
1326072604 | BLUE CROSS BLUE SHIELD (01) | TX |
8BC020 | BCBS (01) | TX |
G21580 | (02) | CA |
G21580 | (02) | TX |
P01036931 | RR MEDICARE (01) | TX |