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Organization
STATE OF LOUISIANA
Active
Organization
STATE OF LOUISIANA
Active
Other names
Southeastern Louisiana Sports Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
MOUZON BASS (AGENT)
(972) 367-4845
Entity
Organization
Contact information
Practice address
548 WESTERN AVE, HAMMOND, LA 70402-0001
(972) 367-4845
(972) 367-3451
Mailing address
PO BOX 650850, DEPT 1011, DALLAS, TX 75265-0850
(800) 555-9073
(972) 367-3452
Taxonomy
Speciality
Code
Description
License number
State
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
—
—
207X00000X
Orthopaedic Surgery Physician
—
—
Other
Enumeration date
04/22/2015
Last updated
04/22/2015
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