MEDICARE: GEORGE FAM HAKIM GOBRIAL MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	207RC0000X	Cardiovascular Disease Physician	ME148519	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	ME148519	OTHER	FL	MEDICAL LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1881002889
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GEORGE FAM HAKIM GOBRIAL MD

Provider Business Mailing Address
First Line	:	601 OAK COMMONS BLVD
Second Line	:
City	:	KISSIMMEE
State	:	FL
Zip	:	34741-6620
Country	:	US
Telephone Number	:	407-846-0626
Fax Number	:	407-846-2524

Provider Business Practice Location Address
First Line	:	601 OAK COMMONS BLVD
Second Line	:
City	:	KISSIMMEE
State	:	FL
Zip	:	34741-6620
Country	:	US
Telephone Number	:	407-846-0626
Fax Number	:	407-846-2524

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/23/2014
Last Update Date	:	09/13/2021

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