Healthcare Provider Details

I. General information

NPI: 1205361292
Provider Name (Legal Business Name): BISHER MUSTAFA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2017
Last Update Date: 12/09/2021
Certification Date: 12/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1249 15TH ST SUITE 2000
HUNTINGTON WV
25701-3662
US

IV. Provider business mailing address

SHEIKH SUROOR COMPOUND VILLA #4
ABU DHABI ABU DHABI
784
AE

V. Phone/Fax

Practice location:
  • Phone: 304-691-1000
  • Fax: 304-691-1693
Mailing address:
  • Phone: 971507204500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number01068041A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number27609
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: