NPI 1336538917

The Trustees of Indiana University

Organisation Family Medicine Physician Bloomington, IN

Practice location

Address: 1001 E 17th St Assembly Hall, Bloomington, IN 47408-1590
Phone: (812) 237-3883
Fax: (972) 367-3451
Mailing address: 5050 Spring Valley Rd, Dallas, TX 75244-3995

Authorised official

Name: Mouzon Bass
Title: Agent
Phone: (800) 555-9073

Registered specialties (2)

Family Medicine Physician Primary

Allopathic & Osteopathic Physicians Taxonomy 207Q00000X

Other Family Medicine providers in Indiana →

Sports Medicine (Family Medicine) Physician

Allopathic & Osteopathic Physicians Taxonomy 207QS0010X

Registry record

NPI: 1336538917
Entity type: Organization
NPI issued: 20 Jan 2015
Record last updated: 20 Jan 2015

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.