10D0893882 CLIA NUMBER - MARIA D DOHERTY MD

Laboratory Demographics

  • CLIA Code: 10D0893882
  • Facility Name: MARIA D DOHERTY MD
  • Facility Address: 11525 CORTEZ BLVD
    BROOKSVILLE, FL
    ZIP 34613
  • Facility Phone: 904 796-1492
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: MARIA D. DOHERTY
  • NPI Number: 1982657193
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 10D0893882
LAB Type Physician Office
Facility Name MARIA D DOHERTY MD
Street 11525 CORTEZ BLVD
City BROOKSVILLE
State FL
ZIP 34613
Phone 904 796-1492
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/5/2025
Certificate Expiration Date 6/4/2027
Facility Type Physician Office
Lab Director MARIA D. DOHERTY

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This page was last updated on: 9/29/2025