Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Edward Waters University

Organization Sports Medicine (Family Medicine) Physician · NPI 1609596592

Edward Waters University is a Sports Medicine (Family Medicine) Physician in Jacksonville, Florida. Registered with an NPI since 2022.

In the registry since
2022

Practice location Address checks out

1658 Kings Rd
Jacksonville, FL 32209-6167
Phone: (972) 367-4845
Fax: (972) 367-3451
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Sports Medicine (Family Medicine) Physician (primary) Taxonomy 207QS0010X

Record details

NPI number1609596592
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Mouzon Bass — Ceo/Administrator · (972) 367-4845
Other names Ewc Sports Medicine
NPI enumeratedAugust 31, 2022
Last updated in NPPESAugust 31, 2022
Certification dateAugust 29, 2022
Mailing address15305 Dallas Pkwy Ste 800, Addison, TX 75001-6415

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