MEDICARE: DAVID VIRGIL OXNER JR. CDCA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	170574	OH

General Provider Information

NPI Number	:	1083247415
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID VIRGIL OXNER JR. CDCA

Provider Business Mailing Address
First Line	:	2822 UPTON AVE
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43606-3959
Country	:	US
Telephone Number	:	419-737-6021
Fax Number	:

Provider Business Practice Location Address
First Line	:	2822 UPTON AVE
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43606-3959
Country	:	US
Telephone Number	:	419-737-6021
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/13/2020
Last Update Date	:	02/13/2020

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