Provider Demographics
NPI:1477725455
Name:BRELAND, RYAN BAKER (MD)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:BAKER
Last Name:BRELAND
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 1:132 HWY 280 BLDG 1A
Mailing Address - Street 2:
Mailing Address - City:AMERICUS
Mailing Address - State:GA
Mailing Address - Zip Code:31719-8645
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1500 ROSS CLARK CIR
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36301-4754
Practice Address - Country:US
Practice Address - Phone:334-793-2663
Practice Address - Fax:334-836-2248
Is Sole Proprietor?:No
Enumeration Date:2008-03-30
Last Update Date:2020-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD.33550207X00000X
KY46371207XX0005X
GA82519207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003153634AMedicaid
AL163853Medicaid
AL1477725455OtherMEDICARE ID
AL511-52484OtherBCBS OF AL - HEALTHWEST
AL163245Medicaid
AL511-52483OtherBCBS OF AL - RCC