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Organization

DIXIE STATE UNIVERSITY

Active
Other names
DSU Sports Medicine
Organization subpart
No

Provider details

NPI number
Authorized official
MOUZON BASS (AGENT)
(972) 367-4845
Entity
Organization

Contact information

Practice address
225 S 700 E, ST GEORGE, UT 84770-3875
(435) 652-7850
(972) 367-3452
Mailing address
PO BOX 650850, DALLAS, TX 75265-0850
(800) 555-9073
(972) 367-3452

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
207QS0010X
Sports Medicine (Family Medicine) Physician

Other

Enumeration date
08/04/2015
Last updated
08/04/2015
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