Organization
UNION COLLEGE
Active
Other names
Union 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
310 COLLEGE ST, LAKESIDE BLDG, BARBOURVILLE, KY 40906-1410
(972) 367-4845
Mailing address
5050 SPRING VALLEY RD., DALLAS, TX 75244-3909
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
25858
KY
Other
Enumeration date
02/14/2017
Last updated
02/14/2017
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