Organization
EMPORIA STATE UNIVERSITY
Active
Other names
Emporia State 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
5050 SPRING VALLEY RD, DALLAS, TX 75244-3909
(972) 367-4845
Mailing address
1 KELLOGG CIR, EMPORIA, KS 66801-5415
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
—
—
Other
Enumeration date
05/23/2016
Last updated
05/31/2016
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