Organization
GLENVILLE STATE COLLEGE
Active
Other names
Glenville Sports Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
MOUZON BASS III (ADMINISTRATOR/AGENT)
(972) 367-4845
Entity
Organization
Contact information
Practice address
200 HIGH ST, GLENVILLE, WV 26351-1200
(972) 367-4845
Mailing address
5050 SPRING VALLEY RD, DALLAS, TX 75244-3995
Taxonomy
Speciality
Code
Description
License number
State
207RS0010X
Sports Medicine (Internal Medicine) Physician
Primary
—
—
Other
Enumeration date
01/07/2020
Last updated
01/07/2020
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