Provider Demographics
NPI:1356638332
Name:EBERLE, BRYAN JAMES (PA)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:JAMES
Last Name:EBERLE
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6580 HEMBREE LN STE 270
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CA
Mailing Address - Zip Code:95492-6885
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6580 HEMBREE LN STE 270
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CA
Practice Address - Zip Code:95492-6885
Practice Address - Country:US
Practice Address - Phone:707-838-2044
Practice Address - Fax:707-838-2150
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-29
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53684363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant