Healthcare Provider Details

I. General information

NPI: 1063661262
Provider Name (Legal Business Name): JOHN VERNON HOUGHTALING MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2008
Last Update Date: 11/03/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2865 N REYNOLDS RD BUILDING A
TOLEDO OH
43615-2068
US

IV. Provider business mailing address

2865 N REYNOLDS RD BUILDING A
TOLEDO OH
43615-2068
US

V. Phone/Fax

Practice location:
  • Phone: 419-578-7200
  • Fax:
Mailing address:
  • Phone: 419-578-7200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number35120904
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: