Organization
W.B. STEWART TIGERS ATHLETICS BOOSTERS
Active
Other names
EWC Sports Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
MOUZON BASS (AGENT)
(972) 367-4845
Entity
Organization
Contact information
Practice address
1658 KINGS RD, JACKSONVILLE, FL 32209-6167
(972) 367-4845
Mailing address
5050 SPRING VALLEY RD, DALLAS, TX 75244-3995
Taxonomy
Speciality
Code
Description
License number
State
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
—
—
Other
Enumeration date
03/19/2018
Last updated
03/19/2018
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