Individual
BRUCE CONRAD PURYEAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1541 KINGS HWY, SHREVEPORT, LA 71103-4228
(318) 626-0000
Mailing address
1541 KINGS HWY, ATTN: PAYOR CREDENTIALING, SHREVEPORT, LA 71103-4228
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
249692
LA
207L00000X
Anesthesiology Physician
29325
AZ
207L00000X
Anesthesiology Physician
DR.0037671
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
620832
—
AZ
01
—
P00286379
MEDICARE RAILROAD
—
Enumeration date
01/23/2006
Last updated
02/06/2026
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