Healthcare Provider Details

I. General information

NPI: 1588530521
Provider Name (Legal Business Name): BRYCE ALAN MAGGARD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2025
Last Update Date: 10/16/2025
Certification Date: 10/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7058 CORPORATE WAY STE 3
DAYTON OH
45459-4243
US

IV. Provider business mailing address

7058 CORPORATE WAY STE 3
DAYTON OH
45459-4243
US

V. Phone/Fax

Practice location:
  • Phone: 937-991-0080
  • Fax: 937-991-0083
Mailing address:
  • Phone: 937-991-0080
  • Fax: 937-991-0083

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number006488
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: