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Organization
FLORIDA INSTITUTE OF TECHNOLOGY
Active
Organization
FLORIDA INSTITUTE OF TECHNOLOGY
Active
Other names
FLORIDA TECH ATHLETICS
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MOUZON BASS III (ADMINISTRATOR/AGENT)
(972) 367-4845
Entity
Organization
Contact information
Practice address
150 W UNIVERSITY BLVD, MELBOURNE, FL 32901-8995
(972) 367-4845
Mailing address
15305 DALLAS PKWY STE 800, ADDISON, TX 75001-6415
Taxonomy
Speciality
Code
Description
License number
State
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
—
—
Other
Enumeration date
04/08/2022
Last updated
04/08/2022
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