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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