Provider Demographics
NPI:1124359203
Name:OXFORD, MATTHEW WILLIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:WILLIAM
Last Name:OXFORD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 W FRONT ST
Mailing Address - Street 2:
Mailing Address - City:SLATER
Mailing Address - State:MO
Mailing Address - Zip Code:65349-1328
Mailing Address - Country:US
Mailing Address - Phone:660-529-2251
Mailing Address - Fax:660-831-3328
Practice Address - Street 1:420 W FRONT ST
Practice Address - Street 2:
Practice Address - City:SLATER
Practice Address - State:MO
Practice Address - Zip Code:65349-1328
Practice Address - Country:US
Practice Address - Phone:660-529-2251
Practice Address - Fax:660-831-3348
Is Sole Proprietor?:No
Enumeration Date:2010-01-29
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013031936207Q00000X
MEMD18846207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1124359203Medicaid
MEP00971148Medicare PIN
MO1124359203Medicaid
ME002333201Medicare PIN
ME002333202Medicare PIN