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Organization
SALVE REGINA UNIVERSITY
Active
Organization
SALVE REGINA UNIVERSITY
Active
Other names
Salve Regina Sports Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
MOUZON BASS III (AGENT)
(972) 367-4845
Entity
Organization
Contact information
Practice address
100 OCHRE POINT AVE, NEWPORT, RI 02840-4149
(972) 367-4845
Mailing address
15305 DALLAS PKWY STE 800, ADDISON, TX 75001-6415
(972) 367-4845
Taxonomy
Speciality
Code
Description
License number
State
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
15220
RI
Other
Enumeration date
09/08/2017
Last updated
12/17/2021
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