# DIXIE STATE UNIVERSITY

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

## Provider details

- **NPI number:** 1316323165
- **Authorized official:** MOUZON BASS (AGENT)
- **Authorized official phone:** (972) 367-4845

## Contact information

- **Practice address:** 225 S 700 E, ST GEORGE, UT 84770-3875
- **Practice address phone:** (435) 652-7850
- **Practice address fax:** (972) 367-3452
- **Mailing address:** PO BOX 650850, DALLAS, TX 75265-0850
- **Mailing address phone:** (800) 555-9073
- **Mailing address fax:** (972) 367-3452

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 207QS0010X | Sports Medicine (Family Medicine) Physician | — | NULL | — |
| 207QS0010X | Sports Medicine (Family Medicine) Physician | — | — | — |

## Other

- **Enumeration date:** 08/04/2015
- **Last updated:** 08/04/2015