Healthcare Provider Details

I. General information

NPI: 1710285390
Provider Name (Legal Business Name): OXFORD MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2011
Last Update Date: 03/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 NW CORPORATE BLVD STE 202
BOCA RATON FL
33431-7336
US

IV. Provider business mailing address

1800 NW CORPORATE BLVD STE 202
BOCA RATON FL
33431-7336
US

V. Phone/Fax

Practice location:
  • Phone: 877-881-4225
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: CORY GELMON
Title or Position: CFO
Credential:
Phone: 877-881-4225