Organization
TEXAS STATE UNIVERSITY
Active
Organization
TEXAS STATE UNIVERSITY
Active
Other names
Texas State Sports Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
MOUZON BASS III (ADMINISTRATOR/AGENT)
(972) 367-4845
Entity
Organization
Contact information
Practice address
601 UNIVERSITY DRIVE, ATHLETIC ADMINISTRATION COMPLEX, SAN MARCOS, TX 78666
(972) 367-4845
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
11/21/2019
Last updated
12/17/2021
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