Healthcare Provider Details

I. General information

NPI: 1073877338
Provider Name (Legal Business Name): BRYAN ANTHONY EBERLE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2012
Last Update Date: 11/04/2025
Certification Date: 11/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1708 YAKIMA AVE STE 120
TACOMA WA
98405-5300
US

IV. Provider business mailing address

1708 YAKIMA AVE STE 120
TACOMA WA
98405-5300
US

V. Phone/Fax

Practice location:
  • Phone: 253-596-3696
  • Fax: 253-596-3753
Mailing address:
  • Phone: 253-596-3696
  • Fax: 253-596-3753

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD60783056
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberMD60783056
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: