MEDICARE: DR. FIYINFOLU TOBI MUSTAPHA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	W1859	TX
2	207P00000X	Emergency Medicine Physician	W1859	TX

General Provider Information

NPI Number	:	1679213342
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FIYINFOLU TOBI MUSTAPHA MD

Provider Business Mailing Address
First Line	:	3401 ALTA MERE DR STE C
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76116-7111
Country	:	US
Telephone Number	:	817-210-4229
Fax Number	:

Provider Business Practice Location Address
First Line	:	3401 ALTA MERE DR STE C
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76116-7111
Country	:	US
Telephone Number	:	817-210-4229
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/31/2022
Last Update Date	:	04/18/2026

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