MEDICARE: BRUCE CONRAD PURYEAR MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician	DR.0037671	CO
2	207L00000X	Anesthesiology Physician	29325	AZ
3	207L00000X	Anesthesiology Physician	249692	LA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00286379	OTHER		MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1821068016
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRUCE CONRAD PURYEAR MD

Provider Business Mailing Address
First Line	:	1541 KINGS HWY
Second Line	:	ATTN: PAYOR CREDENTIALING
City	:	SHREVEPORT
State	:	LA
Zip	:	71103-4228
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1541 KINGS HWY
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71103-4228
Country	:	US
Telephone Number	:	318-626-0000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/23/2006
Last Update Date	:	02/06/2026

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Directions to “ BRUCE CONRAD PURYEAR MD” Practice Location

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