Organization
MISSOURI SOUTHERN STATE UNIVERSITY
Active
Organization
MISSOURI SOUTHERN STATE UNIVERSITY
Active
Other names
Missouri Southern 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
3950 NEWMAN RD, JOPLIN, MO 64801-1512
(417) 625-9300
Mailing address
5050 SPRING VALLEY RD., DALLAS, TX 75244
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
112693
MO
Other
Enumeration date
10/20/2016
Last updated
10/20/2016
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