Organization
TABOR COLLEGE
Active
Other names
Tabor 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
400 S JEFFERSON ST, HILLSBORO, KS 67063-1753
(972) 367-4845
Mailing address
5050 SPRING VALLEY RD., DALLAS, TX 75244-3909
Taxonomy
Speciality
Code
Description
License number
State
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
04-34857
KS
Other
Enumeration date
02/24/2017
Last updated
02/24/2017
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