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Alabama State University — NPI 1205356938, Montgomery, AL | NPI Central

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NPI 1205356938

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Alabama State University

NPI 1205356938 · Sports Medicine (Orthopaedic Surgery) Physician · Montgomery, AL

Provider details

NPI number: 1205356938
Entity type: Organization
Primary specialty: Sports Medicine (Orthopaedic Surgery) PhysicianAllopathic & Osteopathic Physicians
Organization subpart: No
Authorized official: Mouzon Bass, Agent(972) 367-4845
License: 32588 (AL)

Specialties & taxonomies

Sports Medicine (Orthopaedic Surgery) PhysicianPrimary207XX0005XLicense 32588 (AL)
Allopathic & Osteopathic Physicians

Practice location

915 S Jackson St

Montgomery, AL 36104-5716

Phone: (972) 367-4845

Approximate (ZIP-level) locationGet directions

More AL providers

Mailing address

5050 Spring Valley Rd

Dallas, TX 75244-3995

Other names (DBA / former)

Doing business as: Alabama State Sports Medicine

Registry dates

Enumerated: 2017-06-23
Last updated: 2017-06-23

Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.