Organization
ALABAMA STATE UNIVERSITY
Active
Other names
Alabama State Sports Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
MOUZON BASS III (AGENT)
(972) 367-4845
Entity
Organization
Contact information
Practice address
915 S JACKSON ST, MONTGOMERY, AL 36104-5716
(972) 367-4845
Mailing address
5050 SPRING VALLEY RD, DALLAS, TX 75244-3995
Taxonomy
Speciality
Code
Description
License number
State
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
Primary
32588
AL
Other
Enumeration date
06/23/2017
Last updated
06/23/2017
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