Organization
CENTRAL METHODIST UNIVERSITY
Active
Other names
Central Methodist University Sports Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
MOUZON BASS III (AGENT)
(972) 367-4845
Entity
Organization
Contact information
Practice address
411 CENTRAL METHODIST SQ, FAYETTE, MO 65248-1104
(660) 248-6346
Mailing address
5050 SPRING VALLEY RD., DALLAS, TX 75244-3909
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
2001007784
MO
Other
Enumeration date
10/19/2016
Last updated
10/19/2016
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