Organization
JACKSONVILLE STATE UNIVERSITY
Active
Other names
Jacksonville State 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
700 PELHAM RD N, JACKSONVILLE, AL 36265-1602
(256) 782-5369
Mailing address
5050 SPRING VALLEY RD., DALLAS, TX 75244-3909
Taxonomy
Speciality
Code
Description
License number
State
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
10954
AL
Other
Enumeration date
09/01/2016
Last updated
09/01/2016
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