Organization
GEORGE MASON UNIVERSITY
Active
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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