Provider Demographics
NPI:1427092212
Name:DURELL, BRUCE R (MD)
Entity type:Individual
Prefix:
First Name:BRUCE
Middle Name:R
Last Name:DURELL
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6614 CAPTIVA PASS
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46168-8000
Mailing Address - Country:US
Mailing Address - Phone:317-679-0145
Mailing Address - Fax:
Practice Address - Street 1:6614 CAPTIVA PASS
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IN
Practice Address - Zip Code:46168-8000
Practice Address - Country:US
Practice Address - Phone:317-679-0145
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01035248207Q00000X
IN01035248A208VP0000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200103280Medicaid
INE95163Medicare UPIN
IN144020FMedicare PIN