Provider Demographics
NPI:1558343798
Name:BOLAND, RYAN FRANKLIN (MD)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:FRANKLIN
Last Name:BOLAND
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 13827
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31416-3827
Mailing Address - Country:US
Mailing Address - Phone:912-352-2299
Mailing Address - Fax:912-352-0012
Practice Address - Street 1:1615 E MONTGOMERY CROSS RD
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-5056
Practice Address - Country:US
Practice Address - Phone:912-352-2299
Practice Address - Fax:912-352-0012
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA030958207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00399473FMedicaid
GA1108070001OtherMEDICARE DME
GA18BDDTZMedicare ID - Type Unspecified
GA00399473FMedicaid