Organization
OTTAWA UNIVERSITY
Active
Other names
Ottawa Sports Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
MOUZON BASS III (AGENT)
(972) 367-4845
Entity
Organization
Contact information
Practice address
15950 N. CIV CENTER PLAZA, SURPRIZE, AZ 85374
(972) 367-4845
Mailing address
5050 SPRING VALLEY RD, DALLAS, TX 75244-3995
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
31375
AZ
Other
Enumeration date
10/17/2017
Last updated
10/17/2017
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