NPI Code Detail JSON Logo

1972801397 NPI number — JONATHAN BRAD EGBERT M.D.

NPI Number: 1972801397
Health Care Provider/Practitioner: JONATHAN BRAD EGBERT M.D.

Information about “1972801397” NPI (JONATHAN BRAD EGBERT M.D.) exists in 1972801397 in HTML format HTML  |  1972801397 in plain Text format TXT  |  1972801397 in PDF (Portable Document Format) PDF  |  1972801397 in an XML format XML  formats.

NPI Number : 1972801397 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1972801397",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "EGBERT",
    "FirstName": "JONATHAN",
    "MiddleName": "BRAD",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "M.D.",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "EGBERT",
    "OtherFirstName": "JONATHAN",
    "OtherMiddleName": "BRAD",
    "OtherNamePrefix": "MR.",
    "OtherNameSuffix": null,
    "OtherCredential": "D.C.",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "2570 NW EDENBOWER BLVD STE 100",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "ROSEBURG",
    "MailingAddressStateName": "OR",
    "MailingAddressPostalCode": "97471-6214",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "541-677-7200",
    "MailingAddressFaxNumber": "541-229-3309",
    "FirstLinePracticeLocationAddress": "2570 NW EDENBOWER BLVD STE 100",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "ROSEBURG",
    "PracticeLocationAddressStateName": "OR",
    "PracticeLocationAddressPostalCode": "97471-6214",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "541-677-7200",
    "PracticeLocationAddressFaxNumber": "541-229-3309",
    "EnumerationDate": "03/09/2011",
    "LastUpdateDate": "04/25/2022",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "111N00000X",
          "TaxonomyName": "Chiropractor",
          "LicenseNumber": "CHIA1449",
          "LicenseNumberStateCode": "ID",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "207Q00000X",
          "TaxonomyName": "Family Medicine Physician",
          "LicenseNumber": "098-T2",
          "LicenseNumberStateCode": "WY",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "207Q00000X",
          "TaxonomyName": "Family Medicine Physician",
          "LicenseNumber": "MD193108",
          "LicenseNumberStateCode": "OR",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY  GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
      }
    }
  }
}
                
            

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