Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | G272 | TX |
NPI | 1023018470 |
---|---|
Provider Name | Eid B Mustafa |
First Address | Wichita Falls, TX 76301-5601 |
Second Address | Wichita Falls, TX 76301-5601 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2005 |
Last Update Date | 12/05/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
120179005 | (05) | TX |
240006708 | RAILROAD MEDICARE PIN (01) |