Organization
OLIVET COLLEGE
Active
Other names
Olivet College Sports Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
MOUZON BASS III (AGENT)
(972) 367-4845
Entity
Organization
Contact information
Practice address
320 S MAIN ST, OLIVET, MI 49076-9406
(972) 367-4845
Mailing address
5050 SPRING VALLEY RD, DALLAS, TX 75244-3995
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
5101018837
MI
Other
Enumeration date
03/30/2017
Last updated
03/30/2017
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