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General NPI Number Information
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NPI Number | 1043302243
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Entity Type | Organization
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Legal Business Name | EID B. MUSTAFA, MD PA
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Dates
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Enumeration Date | 09/28/2006
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Last Update Date | 06/25/2008
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Provider Practice Location Address
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Address Line | 1201 BROOK AVENUE
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City | WICHITA FALLS
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State | TX
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Zip | 76301-5601
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Country | US
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Telephone | 940-322-1122
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Fax | 940-767-8918
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Provider Business Mailing Address
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Address Line | 1201 BROOK AVENUE
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City | WICHITA FALLS
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State | TX
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Zip | 76301-5601
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Country | US
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Telephone | 940-322-1122
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Fax | 940-767-8918
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Authorized Official
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Title or Position | BUSINESS OFFICE
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Name | MRS. DAWN STIVERS
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Credential |
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Telephone | 940-322-1122
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2082S0105X
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Taxonomy Name | Surgery of the Hand (Plastic Surgery) Physician
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License Number | G2792
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 2086S0122X
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Taxonomy Name | Plastic and Reconstructive Surgery Physician
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License Number | G2792
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License Number State | TX
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