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Organization
CULVER-STOCKTON COLLEGE
Active
Organization
CULVER-STOCKTON COLLEGE
Active
Other names
Culver-Stockton Sports Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
MOUZON BASS III (AGENT)
(972) 367-4845
Entity
Organization
Contact information
Practice address
1 COLLEGE HL, CANTON, MO 63435-1257
(972) 367-4845
Mailing address
5050 SPRING VALLEY RD, DALLAS, TX 75244-3995
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
NULL
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
05/24/2017
Last updated
05/24/2017
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