Organization
OKLAHOMA WESLEYAN UNIVERSITY
Active
Other names
OKWU Sports Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
MOUZON BASS III (AGENT)
(972) 367-4845
Entity
Organization
Contact information
Practice address
2201 SILVER LAKE RD, BARTLESVILLE, OK 74006-6233
(972) 367-4845
Mailing address
5050 SPRING VALLEY RD, DALLAS, TX 75244-3995
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
3219
OK
Other
Enumeration date
09/15/2017
Last updated
09/15/2017
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