Provider Demographics
NPI:1932279239
Name:EID B. MUSTAFA
Entity Type:Organization
Organization Name:EID B. MUSTAFA
Other - Org Name:PLASTIC SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EID
Authorized Official - Middle Name:B
Authorized Official - Last Name:MUSTAFA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:940-322-1122
Mailing Address - Street 1:1201 BROOK AVE
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76301-5601
Mailing Address - Country:US
Mailing Address - Phone:940-322-1122
Mailing Address - Fax:940-767-8918
Practice Address - Street 1:1201 BROOK AVE
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76301-5601
Practice Address - Country:US
Practice Address - Phone:940-322-1122
Practice Address - Fax:940-767-8918
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical