Provider Demographics
NPI:1114011228
Name:OXHORN, RICHARD S (PHD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:S
Last Name:OXHORN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9088 SWEET TREE TRL
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-9672
Mailing Address - Country:US
Mailing Address - Phone:904-625-1101
Mailing Address - Fax:
Practice Address - Street 1:204 LAGUNA VILLA BLVD
Practice Address - Street 2:A-23
Practice Address - City:JACKSONVILLE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32250-4053
Practice Address - Country:US
Practice Address - Phone:904-625-1101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY6210103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL54646Medicare PIN