Provider Demographics
NPI:1194728279
Name:GHOBRIAL, VICTOR G (MD)
Entity type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:G
Last Name:GHOBRIAL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 1289
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34206-1289
Mailing Address - Country:US
Mailing Address - Phone:941-746-7444
Mailing Address - Fax:941-746-1777
Practice Address - Street 1:250 2ND ST E
Practice Address - Street 2:SUITE 3A
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34208-1029
Practice Address - Country:US
Practice Address - Phone:941-746-7444
Practice Address - Fax:941-746-1777
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-23
Last Update Date:2010-11-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME87238207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL268871900Medicaid
DF1789OtherRR MEDICARE
FL37741OtherBCBS OF FL
FL203296732OtherTAX ID
FL37741OtherBCBS OF FL
FL203296732OtherTAX ID