Provider Demographics
NPI:1437536869
Name:MOHR, BRYCE A (MD)
Entity Type:Individual
Prefix:
First Name:BRYCE
Middle Name:A
Last Name:MOHR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:250 N SHADELAND AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:317-962-3834
Mailing Address - Fax:
Practice Address - Street 1:2625 E 62ND ST STE 2010
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46220-0037
Practice Address - Country:US
Practice Address - Phone:317-251-6121
Practice Address - Fax:317-257-0390
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-06
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN390200000207Q00000X
IN01080746A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine