Organization
SAINT MARTIN'S UNIVERSITY
Active
Other names
SAINT MARTIN'S UNIVERSITY ATHLETICS
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MOUZON BASS III (ADMINISTRATOR/AGENT)
(972) 367-4845
Entity
Organization
Contact information
Practice address
5000 ABBEY WAY SE, LACEY, WA 98503-3200
(972) 367-4845
Mailing address
15305 DALLAS PKWY STE 800, ADDISON, TX 75001-6415
(972) 367-4845
(972) 367-3451
Taxonomy
Speciality
Code
Description
License number
State
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
—
—
Other
Enumeration date
10/03/2023
Last updated
10/03/2023
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