Healthcare Provider Details

I. General information

NPI: 1568519957
Provider Name (Legal Business Name): OXFORD CARDIOVASCULAR PHYSICIANS, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 06/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

551 AZALEA DR
OXFORD MS
38655-7900
US

IV. Provider business mailing address

551 AZALEA DR
OXFORD MS
38655-7900
US

V. Phone/Fax

Practice location:
  • Phone: 662-234-0332
  • Fax: 662-234-2891
Mailing address:
  • Phone: 662-234-0332
  • Fax: 662-234-2891

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. LAURA FOWLKES
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 662-234-0332