Provider Demographics
NPI:1235228925
Name:UROLOGY OF OXFORD, PLLC
Entity Type:Organization
Organization Name:UROLOGY OF OXFORD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DENIS
Authorized Official - Middle Name:A
Authorized Official - Last Name:YALKUT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:662-234-2313
Mailing Address - Street 1:2166 S LAMAR BLVD
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MS
Mailing Address - Zip Code:38655-5224
Mailing Address - Country:US
Mailing Address - Phone:662-234-2313
Mailing Address - Fax:662-234-2314
Practice Address - Street 1:2166 S LAMAR BLVD
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655-5224
Practice Address - Country:US
Practice Address - Phone:662-234-2313
Practice Address - Fax:662-234-2314
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS15494208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS2021868Medicaid
MSG69251Medicare UPIN
MS340000274Medicare ID - Type Unspecified