Organization
UNIVERSITY OF TENNESSEE MARTIN
Active
Organization
UNIVERSITY OF TENNESSEE MARTIN
Active
Other names
UT-Martin Sports Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
MOUZON BASS (AGENT)
(972) 367-4845
Entity
Organization
Contact information
Practice address
95 MOUNT PELIA RD, ELAM CENTER, MARTIN, TN 38238-0001
(972) 367-4845
Mailing address
5050 SPRING VALLEY RD, DALLAS, TX 75244-3995
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
54536
TN
Other
Enumeration date
04/20/2017
Last updated
04/20/2017
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