Healthcare Provider Details

I. General information

NPI: 1194813493
Provider Name (Legal Business Name): MARY ELLEN WECHTER M.D., M.P.H.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 02/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

836 PRUDENTIAL DR SUITE 1600
JACKSONVILLE FL
32207-8334
US

IV. Provider business mailing address

PO BOX 16568
JACKSONVILLE FL
32245-6568
US

V. Phone/Fax

Practice location:
  • Phone: 904-399-4862
  • Fax: 904-402-8948
Mailing address:
  • Phone: 904-472-2300
  • Fax: 904-472-2330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberME101802
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: