Provider Demographics
NPI:1205361292
Name:MUSTAFA, BISHER (MD)
Entity Type:Individual
Prefix:DR
First Name:BISHER
Middle Name:
Last Name:MUSTAFA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:SHEIKH SUROOR COMPOUND
Mailing Address - Street 2:VILLA #4
Mailing Address - City:ABU DHABI
Mailing Address - State:ABU DHABI
Mailing Address - Zip Code:784
Mailing Address - Country:AE
Mailing Address - Phone:97150-720-4500
Mailing Address - Fax:
Practice Address - Street 1:1249 15TH ST
Practice Address - Street 2:SUITE 2000
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701-3662
Practice Address - Country:US
Practice Address - Phone:304-691-1000
Practice Address - Fax:304-691-1693
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-27
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01068041A207R00000X
WV27609207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine