Provider Demographics
NPI:1790764405
Name:BENDER, BRUCE HAROLD (MD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:HAROLD
Last Name:BENDER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:701 E COUNTY LINE RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-1070
Mailing Address - Country:US
Mailing Address - Phone:317-885-2860
Mailing Address - Fax:317-885-2869
Practice Address - Street 1:701 E COUNTY LINE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46143-1070
Practice Address - Country:US
Practice Address - Phone:317-885-2860
Practice Address - Fax:317-885-2869
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01022089207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100385900Medicaid
IN065940AMedicare PIN