Provider Demographics
NPI:1033126164
Name:MUSA, MUSTAFA IBRAHIM (MD)
Entity Type:Individual
Prefix:DR
First Name:MUSTAFA
Middle Name:IBRAHIM
Last Name:MUSA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:755 N 11TH ST
Mailing Address - Street 2:SUITE P-5200
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77702-1501
Mailing Address - Country:US
Mailing Address - Phone:409-898-2994
Mailing Address - Fax:409-899-5542
Practice Address - Street 1:755 N 11TH ST
Practice Address - Street 2:SUITE P-5200
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77702-1501
Practice Address - Country:US
Practice Address - Phone:409-898-2994
Practice Address - Fax:409-899-5542
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2014-09-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXK8363207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG38776Medicare UPIN