Individual
JEFFREY J ICKLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
10241 BONEY AVE STE A, DIBERVILLE, MS 39540-4889
(228) 967-7651
(228) 967-7653
Mailing address
10241 BONEY AVE STE A, DIBERVILLE, MS 39540-4889
(228) 967-7651
(228) 967-7653
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
00022258
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009998120
—
AL
Enumeration date
09/06/2006
Last updated
05/07/2025
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