Organization
EID B. MUSTAFA, MD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. DAWN STIVERS (BUSINESS OFFICE)
(940) 322-1122
Entity
Organization
Contact information
Practice address
1201 BROOK AVENUE, WICHITA FALLS, TX 76301-5601
(940) 322-1122
(940) 767-8918
Mailing address
1201 BROOK AVENUE, WICHITA FALLS, TX 76301-5601
(940) 322-1122
(940) 767-8918
Taxonomy
Speciality
Code
Description
License number
State
2082S0105X
Surgery of the Hand (Plastic Surgery) Physician
G2792
TX
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
G2792
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
171591401
—
TX
01
—
240006708
RR MEDICARE IDENTIFIER
TX
Enumeration date
09/28/2006
Last updated
06/25/2008
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