Organization
MILLIGAN COLLEGE
Active
Other names
Milligan College Sports Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
MOUZON BASS (AGENT)
(972) 367-4845
Entity
Organization
Contact information
Practice address
ONE BLOWERS BLVD., ATHLETICS, MILLIGAN COLLEGE, TN 37682
(972) 367-4845
Mailing address
5050 SPRING VALLEY RD, DALLAS, TX 75244-3995
Taxonomy
Speciality
Code
Description
License number
State
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
000024265
TN
Other
Enumeration date
07/31/2017
Last updated
07/31/2017
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