Provider Demographics
NPI:1962796649
Name:BRIGHT, DREW W (MD)
Entity type:Individual
Prefix:
First Name:DREW
Middle Name:W
Last Name:BRIGHT
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 1:503 GREENWOOD TRACE DR
Mailing Address - Street 2:
Mailing Address - City:WHITELAND
Mailing Address - State:IN
Mailing Address - Zip Code:46184-9278
Mailing Address - Country:US
Mailing Address - Phone:317-535-7447
Mailing Address - Fax:
Practice Address - Street 1:503 GREENWOOD TRACE DR
Practice Address - Street 2:
Practice Address - City:WHITELAND
Practice Address - State:IN
Practice Address - Zip Code:46184-9278
Practice Address - Country:US
Practice Address - Phone:317-535-7447
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-31
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01073409A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201091920Medicaid
IN201091920Medicaid