Organization
THE PENNSYLVANIA STATE UNIVERSITY
Active
Other names
Pennsylvania State University Sports Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
MOUZON BASS III (AGENT)
(972) 367-4845
Entity
Organization
Contact information
Practice address
408 OLD MAIN, UNIVERSITY PARK, PA 16802-1505
(814) 865-4700
Mailing address
5050 SPRING VALLEY RD., DALLAS, TX 75244-3909
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
MD062970L
PA
Other
Enumeration date
09/07/2016
Last updated
02/27/2024
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