Provider Demographics
NPI:1407843725
Name:OXHOLM, LUIS FELIX (DO)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:FELIX
Last Name:OXHOLM
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 SOUTH HOLLY STREET
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97501
Mailing Address - Country:US
Mailing Address - Phone:541-774-8200
Mailing Address - Fax:541-774-7964
Practice Address - Street 1:140 SOUTH HOLLY STREET
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97501
Practice Address - Country:US
Practice Address - Phone:541-774-8200
Practice Address - Fax:541-774-7964
Is Sole Proprietor?:No
Enumeration Date:2005-10-03
Last Update Date:2014-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI51010109932084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIDB8806OtherRAIL ROAD MEDICARE- GRP.
MI2652800431OtherBLUE CROSS BLUE SHIELD
MIP00134275OtherRAIL ROAD MEDICARE- INDIV
MIP81360OtherBLUE CARE NETWORK
MI0N93710Medicare ID - Type UnspecifiedMEDICARE - GROUP
MI2652800431OtherBLUE CROSS BLUE SHIELD