Provider Demographics
NPI:1720193709
Name:DOKLER HELFFRICH, MARYANNE L (MD)
Entity Type:Individual
Prefix:DR
First Name:MARYANNE
Middle Name:L
Last Name:DOKLER HELFFRICH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MARYANNE
Other - Middle Name:LOUISE
Other - Last Name:DOKLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:8055 MAYFIELD RD STE 105
Mailing Address - Street 2:
Mailing Address - City:CHESTERLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44026-2447
Mailing Address - Country:US
Mailing Address - Phone:216-844-3015
Mailing Address - Fax:216-844-8687
Practice Address - Street 1:807 CHILDRENS WAY
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207
Practice Address - Country:US
Practice Address - Phone:904-697-3850
Practice Address - Fax:904-697-3927
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2019-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME511872086S0120X
OH35.0457612086S0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL061878100Medicaid
GA000446498AMedicaid
C16774Medicare UPIN
GA000446498AMedicaid