Provider Demographics
NPI:1942286034
Name:DURSTELER, BRIAN BRUCE (MD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:BRUCE
Last Name:DURSTELER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7021 E EARLL DR
Mailing Address - Street 2:STE 202
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-6318
Mailing Address - Country:US
Mailing Address - Phone:480-949-2764
Mailing Address - Fax:
Practice Address - Street 1:13677 W MCDOWELL RD
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85338-2618
Practice Address - Country:US
Practice Address - Phone:623-882-1500
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ28901207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ3981220OtherEVERCARE GROUP
AZAZ0728670OtherBLUE CROSS & BLUE SHIELD
AW1436OtherHEALTHNET GROUP
AZ545486Medicaid
AZ3981220OtherEVERCARE GROUP
AW1436OtherHEALTHNET GROUP