Organization
OKLAHOMA CITY UNIVERSITY
Active
Other names
OKCU Sports Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
MOUZON BASS III (ADMINISTRATOR/AGENT)
(972) 367-4845
Entity
Organization
Contact information
Practice address
2501 N BLACKWELDER AVE, OKLAHOMA CITY, OK 73106-1402
(972) 367-4845
Mailing address
15305 DALLAS PKWY STE 800, ADDISON, TX 75001-6415
(972) 367-4845
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
Other
Enumeration date
09/18/2018
Last updated
12/17/2021
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