Provider Demographics
NPI:1881556686
Name:EGBERT, BRIAN DAVID
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:DAVID
Last Name:EGBERT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10280 GATEWAY PL UNIT 423
Mailing Address - Street 2:
Mailing Address - City:BLUE ASH
Mailing Address - State:OH
Mailing Address - Zip Code:45242-4699
Mailing Address - Country:US
Mailing Address - Phone:614-266-1744
Mailing Address - Fax:
Practice Address - Street 1:10280 GATEWAY PL UNIT 423
Practice Address - Street 2:
Practice Address - City:BLUE ASH
Practice Address - State:OH
Practice Address - Zip Code:45242-4699
Practice Address - Country:US
Practice Address - Phone:614-266-1744
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-12-01
Last Update Date:2025-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
376J00000X
OHVA506822172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver
No376J00000XNursing Service Related ProvidersHomemaker