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Organization
W.B. STEWART TIGERS ATHLETICS BOOSTERS
Active
Organization
W.B. STEWART TIGERS ATHLETICS BOOSTERS
Active
Other names
EWC Sports Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
MOUZON BASS (AGENT)
(972) 367-4845
Entity
Organization
Contact information
Practice address
1658 KINGS RD, JACKSONVILLE, FL 32209-6167
(972) 367-4845
Mailing address
5050 SPRING VALLEY RD, DALLAS, TX 75244-3995
Taxonomy
Speciality
Code
Description
License number
State
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
—
—
Other
Enumeration date
03/19/2018
Last updated
03/19/2018
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