Organization
LINDENWOOD UNIVERSITY-BELLEVILLE
Active
Organization
LINDENWOOD UNIVERSITY-BELLEVILLE
Active
Other names
Lindenwood University-Belleville Sports Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
MOUZON BASS III (AGENT)
(972) 367-4845
Entity
Organization
Contact information
Practice address
2600 W MAIN ST, BELLEVILLE, IL 62226-6651
(972) 367-4845
Mailing address
5050 SPRING VALLEY RD., DALLAS, TX 75244-3909
Taxonomy
Speciality
Code
Description
License number
State
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
Primary
036129925
IL
Other
Enumeration date
10/27/2016
Last updated
10/27/2016
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