Provider Demographics
NPI:1245438175
Name:CAMPBELL GHEBRANIOUS PLLC
Entity type:Organization
Organization Name:CAMPBELL GHEBRANIOUS PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:AMIR
Authorized Official - Middle Name:R
Authorized Official - Last Name:GHEBRANIOUS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-484-5587
Mailing Address - Street 1:10950 RESOURCE PKWY
Mailing Address - Street 2:SUITE A
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77089-6134
Mailing Address - Country:US
Mailing Address - Phone:281-484-5587
Mailing Address - Fax:281-464-6480
Practice Address - Street 1:10950 RESOURCE PKWY
Practice Address - Street 2:SUITE A
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77089-6134
Practice Address - Country:US
Practice Address - Phone:281-484-5587
Practice Address - Fax:281-464-6480
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-03
Last Update Date:2016-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ9051207R00000X
TXH4207207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00517KOtherBCBS TX PRACTICE ID
TX00517KOtherBCBS TX PRACTICE ID
TX00517KMedicare ID - Type UnspecifiedPRACTICE ID