NPI 1205356938

Alabama State University

Organisation Sports Medicine (Orthopaedic Surgery) Physician Montgomery, AL

Practice location

Address: 915 S Jackson St, Montgomery, AL 36104-5716
Phone: (972) 367-4845
Mailing address: 5050 Spring Valley Rd, Dallas, TX 75244-3995

Authorised official

Name: Mouzon Bass
Title: Agent
Phone: (972) 367-4845

Registered specialties

Sports Medicine (Orthopaedic Surgery) Physician Primary

Allopathic & Osteopathic Physicians Taxonomy 207XX0005X Licence 32588 (AL)

Other Orthopaedic Surgery providers in Alabama →

Registry record

NPI: 1205356938
Entity type: Organization
NPI issued: 23 Jun 2017
Record last updated: 23 Jun 2017

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.