Healthcare Provider Details

I. General information

NPI: 1881556686
Provider Name (Legal Business Name): MR. BRIAN DAVID EGBERT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2025
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10280 GATEWAY PL UNIT 423
BLUE ASH OH
45242-4699
US

IV. Provider business mailing address

10280 GATEWAY PL UNIT 423
BLUE ASH OH
45242-4699
US

V. Phone/Fax

Practice location:
  • Phone: 614-266-1744
  • Fax:
Mailing address:
  • Phone: 614-266-1744
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License NumberVA506822
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: