Organization
NORTH CAROLINA CENTRAL UNIVERSITY
Active
Other names
NCCU Sports Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
MOUZON BASS III (AGENT)
(972) 367-4845
Entity
Organization
Contact information
Practice address
1801 FAYETTEVILLE ST, DURHAM, NC 27707-3129
(919) 530-6215
(972) 367-3451
Mailing address
PO BOX 650850, DEPT 1011, DALLAS, TX 75265-0850
(800) 555-9073
(972) 367-3452
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
207X00000X
Orthopaedic Surgery Physician
—
—
Other
Enumeration date
10/13/2015
Last updated
10/13/2015
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