Provider Demographics
NPI:1073877338
Name:EBERLE, BRYAN ANTHONY (MD)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:ANTHONY
Last Name:EBERLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1708 YAKIMA AVE STE 120
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-5300
Mailing Address - Country:US
Mailing Address - Phone:253-596-3696
Mailing Address - Fax:253-596-3753
Practice Address - Street 1:1708 YAKIMA AVE STE 120
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-5300
Practice Address - Country:US
Practice Address - Phone:253-596-3696
Practice Address - Fax:253-596-3753
Is Sole Proprietor?:No
Enumeration Date:2012-07-01
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60783056207R00000X, 208M00000X
WV29123208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine