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Organization

GEORGE MASON UNIVERSITY

Active
Other names
George Mason University Sports Medicine
Organization subpart
No

Provider details

NPI number
Authorized official
MOUZON BASS III (AGENT)
(972) 367-4845
Entity
Organization

Contact information

Practice address
4400 UNIVERSITY DR, FAIRFAX, VA 22030-4422
(703) 993-1000
Mailing address
5050 SPRING VALLEY RD, DALLAS, TX 75244-3909

Taxonomy

Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
0101024710
VA

Other

Enumeration date
08/01/2016
Last updated
08/01/2016
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