Healthcare Provider Details

I. General information

NPI: 1548327273
Provider Name (Legal Business Name): OXFORD UROLOGY ASSOCIATES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 12/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2168 S LAMAR BLVD
OXFORD MS
38655-5224
US

IV. Provider business mailing address

PO BOX 1013
OXFORD MS
38655-1013
US

V. Phone/Fax

Practice location:
  • Phone: 662-234-1448
  • Fax: 662-234-1103
Mailing address:
  • Phone: 662-234-1448
  • Fax: 662-234-1103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number13909
License Number StateMS

VIII. Authorized Official

Name: MS. AMANDA N GARDNER
Title or Position: OFFICE MANAGER
Credential:
Phone: 662-234-1448