Individual
EID B MUSTAFA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1201 BROOK AVE, WICHITA FALLS, TX 76301-5601
(940) 322-1122
(940) 767-8918
Mailing address
1201 BROOK AVE, WICHITA FALLS, TX 76301-5601
(940) 322-1122
(940) 767-8918
Taxonomy
Speciality
Code
Description
License number
State
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
G272
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
120179005
—
TX
01
—
240006708
RAILROAD MEDICARE PIN
—
Enumeration date
07/28/2005
Last updated
05/12/2014
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