Healthcare Provider Details

I. General information

NPI: 1972801397
Provider Name (Legal Business Name): JONATHAN BRAD EGBERT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: JONATHAN BRAD EGBERT D.C.

II. Dates (important events)

Enumeration Date: 03/09/2011
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1055 N 500 W
PROVO UT
84604-3305
US

IV. Provider business mailing address

1055 N 500 W ATTN CREDENTIALING
PROVO UT
84604-3305
US

V. Phone/Fax

Practice location:
  • Phone: 801-354-8225
  • Fax: 801-418-0941
Mailing address:
  • Phone: 801-354-8225
  • Fax: 801-418-0941

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number14271352-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: