MEDICARE: OXFORD PHYSICIANS MEDICAL GROUP INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician
2	208600000X	Surgery Physician

General Provider Information

NPI Number	:	1265037352
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OXFORD PHYSICIANS MEDICAL GROUP INC

Provider Business Mailing Address
First Line	:	4712 ADMIRALTY WAY
Second Line	:	# 941
City	:	MARINA DEL REY
State	:	CA
Zip	:	90292
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8331 BLERIOT AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90045
Country	:	US
Telephone Number	:	310-622-5369
Fax Number	:	888-413-9650

Authorized Official
Title or Position	:	ANESTHESIOLOGIST
Name	:	ALEXANDER SOROKURS
Credential	:	M.D.
Telephone Number	:	310-622-5369

Provider Enumeration Date	:	12/04/2020
Last Update Date	:	09/06/2023

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