Organization
SAINT PETER'S UNIVERSITY
Active
Other names
SPU Sports Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
MOUZON BASS III (ADMINISTRATOR)
(972) 367-4845
Entity
Organization
Contact information
Practice address
2641 JOHN F KENNEDY BLVD, JERSEY CITY, NJ 07306-5943
(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
—
—
Other
Enumeration date
08/16/2018
Last updated
08/16/2018
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