MEDICARE: OXBOW EMERGENCY PHYSICIANS PLLC

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	207P00000X	Emergency Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	0016MY	OTHER	TX	BLUE SHIELD

General Provider Information

NPI Number	:	1942253588
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OXBOW EMERGENCY PHYSICIANS PLLC

Provider Business Mailing Address
First Line	:	13737 NOEL RD
Second Line	:	STE 1600
City	:	DALLAS
State	:	TX
Zip	:	75240-1331
Country	:	US
Telephone Number	:	954-838-2371
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 MEDICAL DR
Second Line	:
City	:	LAKE JACKSON
State	:	TX
Zip	:	77566-5674
Country	:	US
Telephone Number	:	979-297-4411
Fax Number	:	214-712-2487

Authorized Official
Title or Position	:	OFFICER
Name	:	KAREN VAUGHN
Credential	:
Telephone Number	:	404-450-4684

Provider Enumeration Date	:	05/17/2006
Last Update Date	:	03/22/2023

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