Organization
ST. BONAVENTURE UNIVERSITY
Active
Organization
ST. BONAVENTURE UNIVERSITY
Active
Other names
St. Bonaventure Sports Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
MOUZON BASS III (AGENT)
(972) 367-4845
Entity
Organization
Contact information
Practice address
3261 W STATE RD, SAINT BONAVENTURE, NY 14778-9800
(972) 367-4845
Mailing address
5050 SPRING VALLEY RD, DALLAS, TX 75244-3995
(972) 367-4845
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
211943-2
NY
Other
Enumeration date
06/20/2017
Last updated
06/20/2017
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