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NPI Code Detail

MEDICARE: EID B. MUSTAFA

MEDICARE: EID B. MUSTAFA
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
1261QA1903XAmbulatory Surgical Clinic/Center

General Provider Information

NPI Number : 1932279239
Entity Type Code : Organization
Provider Name (Legal Business Name) : EID B. MUSTAFA
Provider Business Mailing Address
First Line : 1201 BROOK AVE
Second Line :
City : WICHITA FALLS
State : TX
Zip : 76301-5601
Country : US
Telephone Number : 940-322-1122
Fax Number : 940-767-8918
Provider Business Practice Location Address
First Line : 1201 BROOK AVE
Second Line :
City : WICHITA FALLS
State : TX
Zip : 76301-5601
Country : US
Telephone Number : 940-322-1122
Fax Number : 940-767-8918
Authorized Official
Title or Position : OWNER
Name : DR. EID B. MUSTAFA
Credential : MD
Telephone Number : 940-322-1122
Provider Enumeration Date : 11/08/2006
Last Update Date : 08/22/2020

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Directions to “EID B. MUSTAFA ” Practice Location

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