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Organization

UNIVERSITY OF DALLAS

Active
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Organization

UNIVERSITY OF DALLAS

Active
Other names
University of Dallas Sports Medicine
Organization subpart
No

Provider details

NPI number
Authorized official
MOUZON BASS III (AGENT)
(972) 367-4845
Entity
Organization

Contact information

Practice address
1845 E NORTHGATE DR, MAHER ATHLETIC CENTER, IRVING, TX 75062-4736
(972) 721-5010
Mailing address
5050 SPRING VALLEY RD, DALLAS, TX 75244-3995
(800) 555-9073
(972) 367-3452

Taxonomy

Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
2080S0010X
Pediatric Sports Medicine Physician
—
—

Other

Enumeration date
10/13/2015
Last updated
10/13/2015
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