Healthcare Provider Details

I. General information

NPI: 1508914102
Provider Name (Legal Business Name): OXFORD LUNG PHYSICIANS, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 09/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 S LAMAR BLVD STE 100 2301 S LAMAR BLVD STE 100
OXFORD MS
38655-5373
US

IV. Provider business mailing address

PO BOX 768 2301 S LAMAR BLVD. STE 100
OXFORD MS
38655-0768
US

V. Phone/Fax

Practice location:
  • Phone: 662-234-0119
  • Fax: 662-234-0090
Mailing address:
  • Phone: 662-234-0119
  • Fax: 662-234-0090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number12109,17162,R862053
License Number StateMS

VIII. Authorized Official

Name: DR. JEFFREY N EVANS
Title or Position: PRESIDENT OWNER
Credential:
Phone: 662-234-0119