Provider Demographics
NPI:1619919289
Name:GHOBRIEL, ALDO ANTHONY (MD)
Entity Type:Individual
Prefix:
First Name:ALDO
Middle Name:ANTHONY
Last Name:GHOBRIEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3600 GASTON AVE
Mailing Address - Street 2:SUITE 1205
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246-1800
Mailing Address - Country:US
Mailing Address - Phone:214-692-8262
Mailing Address - Fax:214-696-4190
Practice Address - Street 1:890 ROCKWALL PKWY
Practice Address - Street 2:STE 110
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75032-6872
Practice Address - Country:US
Practice Address - Phone:972-276-6191
Practice Address - Fax:972-961-9550
Is Sole Proprietor?:No
Enumeration Date:2006-06-11
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL8063208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX166003702Medicaid
TXI016367Medicare UPIN
TX8G2557Medicare PIN
TX166003702Medicaid