Provider Demographics
NPI:1376783852
Name:MICHEL GOUBRAN MD PA
Entity Type:Organization
Organization Name:MICHEL GOUBRAN MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GOUBRAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:252-354-6500
Mailing Address - Street 1:PO BOX 16199
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27704-7199
Mailing Address - Country:US
Mailing Address - Phone:919-956-2626
Mailing Address - Fax:919-956-2828
Practice Address - Street 1:7901 EMERALD DR
Practice Address - Street 2:SUITE 7
Practice Address - City:EMERALD ISLE
Practice Address - State:NC
Practice Address - Zip Code:28594-2846
Practice Address - Country:US
Practice Address - Phone:252-354-6500
Practice Address - Fax:252-354-5060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-24
Last Update Date:2010-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC21039207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty