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General NPI Number Information
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NPI Number | 1457264996
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Entity Type | Individual
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Provider Name | SOREN BROCKDORF PHD
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Gender | Male
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Dates
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Enumeration Date | 09/25/2026
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Last Update Date | 09/25/2026
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Provider Practice Location Address
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Address Line | 3600 NW 43RD ST STE E4
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City | GAINESVILLE
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State | FL
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Zip | 32606-8134
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Country | US
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Telephone | 904-651-4690
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Fax |
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Provider Business Mailing Address
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Address Line | 5351 NE COUNTY ROAD 340
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City | HIGH SPRINGS
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State | FL
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Zip | 32643-3702
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Country | US
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Telephone | 904-651-4690
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 146L00000X
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Taxonomy Name | Paramedic
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License Number |
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License Number State |
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