Organization
SALVE REGINA UNIVERSITY
Active
Other names
Salve Regina Sports Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
MOUZON BASS III (AGENT)
(972) 367-4845
Entity
Organization
Contact information
Practice address
100 OCHRE POINT AVE, NEWPORT, RI 02840-4149
(972) 367-4845
Mailing address
15305 DALLAS PKWY STE 800, ADDISON, TX 75001-6415
(972) 367-4845
Taxonomy
Speciality
Code
Description
License number
State
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
15220
RI
Other
Enumeration date
09/08/2017
Last updated
12/17/2021
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