Healthcare Provider Details

I. General information

NPI: 1265564249
Provider Name (Legal Business Name): EMMANUEL DJOKOTO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 03/02/2022
Certification Date: 03/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5800 BEACH BLVD STE 105
JACKSONVILLE FL
32207-5180
US

IV. Provider business mailing address

2232 CASCADIA CT
ST AUGUSTINE FL
32092-3417
US

V. Phone/Fax

Practice location:
  • Phone: 904-374-9334
  • Fax: 904-374-9309
Mailing address:
  • Phone: 904-374-9334
  • Fax: 904-374-9309

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS30128
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: