Organization
OAKLAND UNIVERSITY
Active
Other names
Oakland Sports Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
MOUZON BASS III (AGENT)
18005559073
Entity
Organization
Contact information
Practice address
201 ATHLETICS CTR, ROCHESTER, MI 48309
(248) 370-3787
(972) 367-3452
Mailing address
PO BOX 650850, DALLAS, TX 75265-0850
(800) 555-9073
(972) 367-3452
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
—
—
Other
Enumeration date
07/18/2015
Last updated
07/18/2015
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