# UNIVERSITY OF ARKANSAS AT MONTICELLO

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- **Entity:** Organization
- **Status:** Active
- **Other names:** UAM Sports Medicine
- **Organization subpart:** No

## Provider details

- **NPI number:** 1083269690
- **Authorized official:** MOUZON BASS III (ADMINISTRATOR/AGENT)
- **Authorized official phone:** (972) 367-4845

## Contact information

- **Practice address:** 663 UNIVERSITY DRIVE, MONTICELLO, AR 71656
- **Practice address phone:** (870) 460-1058
- **Mailing address:** 5050 SPRING VALLEY RD, DALLAS, TX 75244-3995

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | — | — | Yes |

## Other

- **Enumeration date:** 08/09/2019
- **Last updated:** 08/09/2019