Provider Demographics
NPI:1235265091
Name:WORRELL, BRUCE SAMUEL (DO)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:SAMUEL
Last Name:WORRELL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1119 WINDSAIL CV
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:45140-8097
Mailing Address - Country:US
Mailing Address - Phone:513-677-8146
Mailing Address - Fax:
Practice Address - Street 1:1119 WINDSAIL CV
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:OH
Practice Address - Zip Code:45140-8097
Practice Address - Country:US
Practice Address - Phone:513-677-8146
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-00-2776207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine