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Organization
UNIVERSITY OF ARKANSAS AT MONTICELLO
Active
Organization
UNIVERSITY OF ARKANSAS AT MONTICELLO
Active
Other names
UAM Sports Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
MOUZON BASS III (ADMINISTRATOR/AGENT)
(972) 367-4845
Entity
Organization
Contact information
Practice address
663 UNIVERSITY DRIVE, MONTICELLO, AR 71656
(870) 460-1058
Mailing address
5050 SPRING VALLEY RD, DALLAS, TX 75244-3995
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
—
—
Other
Enumeration date
08/09/2019
Last updated
08/09/2019
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