Provider Demographics
NPI:1467411652
Name:BRODSKY, HAL MARC (MD)
Entity Type:Individual
Prefix:
First Name:HAL
Middle Name:MARC
Last Name:BRODSKY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6900 NW 9TH BLVD
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-4251
Mailing Address - Country:US
Mailing Address - Phone:352-333-6680
Mailing Address - Fax:352-331-4006
Practice Address - Street 1:6900 NW 9TH BLVD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-4251
Practice Address - Country:US
Practice Address - Phone:352-333-6680
Practice Address - Fax:352-331-4006
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2009-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME48768207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL63876500Medicaid
FL10423ZMedicare ID - Type UnspecifiedMEDICARE
FL63876500Medicaid
FLP00723107Medicare PIN
FLE60457Medicare UPIN