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NPI Code Detail

MEDICARE: BASSEM GHOBRIAL M.D.

MEDICARE: BASSEM GHOBRIAL M.D.
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
1208C00000XColon & Rectal Surgery PhysicianA153509CA
2208600000XSurgery PhysicianA153509CA

General Provider Information

NPI Number : 1619359874
Entity Type Code : Individual
Provider Name (Legal Business Name) : BASSEM GHOBRIAL M.D.
Provider Business Mailing Address
First Line : PO BOX 1020
Second Line :
City : STOCKTON
State : CA
Zip : 95201-3120
Country : US
Telephone Number : 209-468-6000
Fax Number : 209-468-7042
Provider Business Practice Location Address
First Line : 500 W HOSPITAL RD
Second Line :
City : FRENCH CAMP
State : CA
Zip : 95231-9693
Country : US
Telephone Number : 209-468-6000
Fax Number : 209-468-7042
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/24/2015
Last Update Date : 03/17/2026

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