Provider Demographics
NPI:1326072604
Name:GHOBRIAL M.D., RAFIK MARK (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:RAFIK
Middle Name:MARK
Last Name:GHOBRIAL M.D.
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:6550 FANNIN ST
Mailing Address - Street 2:SUITE 1601
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2717
Mailing Address - Country:US
Mailing Address - Phone:713-441-5141
Mailing Address - Fax:713-790-6470
Practice Address - Street 1:6550 FANNIN ST
Practice Address - Street 2:SUITE 1601
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2717
Practice Address - Country:US
Practice Address - Phone:713-441-5141
Practice Address - Fax:713-790-6470
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA56109204F00000X
TXJ0883204F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204F00000XAllopathic & Osteopathic PhysiciansTransplant Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX104048705Medicaid
TX1326072604OtherBLUE CROSS BLUE SHIELD
TXP01036931OtherRR MEDICARE
CA00A561090Medicaid
TX104048704Medicaid
TX8BC020OtherBCBS
8K4159Medicare PIN
CAG21580Medicare UPIN
TXP01036931OtherRR MEDICARE
TX1326072604OtherBLUE CROSS BLUE SHIELD
TXTXB145311Medicare PIN
CAWA56109AMedicare PIN