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NPI Code Detail

MEDICARE: DR. MARLENE S GOODFRIEND MD

MEDICARE: DR. MARLENE S GOODFRIEND MD
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
1208000000XPediatrics PhysicianME87093FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1598717761
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARLENE S GOODFRIEND MD
Provider Business Mailing Address
First Line : 515 W 6TH ST
Second Line : MC #24
City : JACKSONVILLE
State : FL
Zip : 32206-4324
Country : US
Telephone Number : 904-665-2410
Fax Number : 904-630-3316
Provider Business Practice Location Address
First Line : 910 N JEFFERSON ST
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32209-6810
Country : US
Telephone Number : 904-359-3842
Fax Number : 904-359-3847
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/16/2006
Last Update Date : 07/08/2007

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Directions to “ DR. MARLENE S GOODFRIEND MD” Practice Location

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