Organization
SAM HOUSTON STATE UNIVERSITY
Active
Organization
SAM HOUSTON STATE UNIVERSITY
Active
Other names
Sam Houston Athletics
Organization subpart
No
Provider details
NPI number
Authorized official
MOUZON BASS (AGENT/ADMINISTRATOR)
(972) 367-4845
Entity
Organization
Contact information
Practice address
1003 17TH STREET ATTN: ATHLETIC DEPARTMENT, HUNTSVILLE, TX 77341-0001
(936) 294-1710
Mailing address
15305 DALLAS PKWY STE 800, ADDISON, TX 75001-6415
(972) 367-4845
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
Other
Enumeration date
10/01/2021
Last updated
12/17/2021
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