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Organization
MISSOURI BAPTIST UNIVERSITY
Active
Organization
MISSOURI BAPTIST UNIVERSITY
Active
Other names
MISSOURI BAPTIST UNIVERSITY ATHLETICS
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MOUZON BASS III (ADMINISTRATOR)
(972) 367-4845
Entity
Organization
Contact information
Practice address
1 COLLEGE PARK DR, SAINT LOUIS, MO 63141-8660
(972) 367-4845
Mailing address
15305 DALLAS PKWY STE 800, ADDISON, TX 75001-6415
(972) 367-4845
Taxonomy
Speciality
Code
Description
License number
State
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
—
NULL
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
—
—
Other
Enumeration date
03/30/2023
Last updated
03/30/2023
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