MEDICARE: DR. VICTOR G. GHOBRIAL 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	207RP1001X	Pulmonary Disease Physician	ME87238	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	DF1789	OTHER		RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	37741	OTHER	FL	BCBS OF FL
4	203296732	OTHER	FL	TAX ID
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194728279
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VICTOR G. GHOBRIAL MD

Provider Business Mailing Address
First Line	:	PO BOX 1289
Second Line	:
City	:	BRADENTON
State	:	FL
Zip	:	34206-1289
Country	:	US
Telephone Number	:	941-746-7444
Fax Number	:	941-746-1777

Provider Business Practice Location Address
First Line	:	250 2ND ST E
Second Line	:	SUITE 3A
City	:	BRADENTON
State	:	FL
Zip	:	34208-1029
Country	:	US
Telephone Number	:	941-746-7444
Fax Number	:	941-746-1777

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

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	11/23/2010

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Directions to “ DR. VICTOR G. GHOBRIAL MD” Practice Location

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