Organization
MINNESOTA STATE UNIVERSITY
Active
Other names
MSU Sports Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
MOUZON BASS III (OFFICE MANAGER)
(972) 367-4845
Entity
Organization
Contact information
Practice address
135 MYERS FIELDHOUSE, MANKATO, MN 56001-6171
(507) 389-2099
(972) 367-3452
Mailing address
PO BOX 650850, DALLAS, TX 75265-0850
(800) 555-9073
(972) 367-3451
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
—
—
Other
Enumeration date
09/25/2015
Last updated
09/25/2015
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