Organization
FLORIDA ATLANTIC UNIVERSITY
Active
Other names
FAU Sports Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
MOUZON BASS III (AGENT)
(800) 555-9073
Entity
Organization
Contact information
Practice address
777 GLADES RD, DEPARTMENT OF ATLHLETICS, BOCA RATON, FL 33431-6424
(800) 555-9073
(972) 367-3452
Mailing address
777 GLADES RD, BOCA RATON, FL 33431-6424
(800) 555-9073
(972) 367-3452
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
Other
Enumeration date
02/05/2015
Last updated
02/05/2015
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