Healthcare Provider Details

I. General information

NPI: 1720193709
Provider Name (Legal Business Name): MARYANNE L. DOKLER HELFFRICH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DR. MARYANNE LOUISE DOKLER

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 06/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

807 CHILDRENS WAY
JACKSONVILLE FL
32207
US

IV. Provider business mailing address

8055 MAYFIELD RD STE 105
CHESTERLAND OH
44026-2447
US

V. Phone/Fax

Practice location:
  • Phone: 904-697-3850
  • Fax: 904-697-3927
Mailing address:
  • Phone: 216-844-3015
  • Fax: 216-844-8687

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0120X
TaxonomyPediatric Surgery Physician
License NumberME51187
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2086S0120X
TaxonomyPediatric Surgery Physician
License Number35.045761
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: