Organization
MONROE COLLEGE
Active
Other names
Monroe 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
434 MAIN ST, NEW ROCHELLE, NY 10801-6410
(972) 367-4845
Mailing address
5050 SPRING VALLEY RD, DALLAS, TX 75244-3995
(972) 367-4845
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
253013
NY
Other
Enumeration date
08/17/2017
Last updated
08/17/2017
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