Provider Demographics
NPI:1487738944
Name:OXNARD, LIDA MILLER (MD)
Entity type:Individual
Prefix:MRS
First Name:LIDA
Middle Name:MILLER
Last Name:OXNARD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:809 MORTON AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BARDSTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40004-2565
Mailing Address - Country:US
Mailing Address - Phone:502-331-0411
Mailing Address - Fax:502-331-0380
Practice Address - Street 1:809 MORTON AVE STE 200
Practice Address - Street 2:SUITE 200
Practice Address - City:BARDSTOWN
Practice Address - State:KY
Practice Address - Zip Code:40004-2565
Practice Address - Country:US
Practice Address - Phone:502-331-0411
Practice Address - Fax:502-331-0380
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY28312207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000052168OtherANTHEM
KY64283120Medicaid
KY0607302Medicare PIN
KY64283120Medicaid