Healthcare Provider Details

I. General information

NPI: 1457264996
Provider Name (Legal Business Name): SOREN BROCKDORF PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2026
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 NW 43RD ST STE E4
GAINESVILLE FL
32606-8134
US

IV. Provider business mailing address

5351 NE COUNTY ROAD 340
HIGH SPRINGS FL
32643-3702
US

V. Phone/Fax

Practice location:
  • Phone: 904-651-4690
  • Fax:
Mailing address:
  • Phone: 904-651-4690
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146L00000X
TaxonomyParamedic
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: