Provider Demographics
NPI:1578730271
Name:BOURNE, RYAN NOLAND (MD)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:NOLAND
Last Name:BOURNE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:8715 VILLAGE DR
Mailing Address - Street 2:STE 400
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-5405
Mailing Address - Country:US
Mailing Address - Phone:210-646-6556
Mailing Address - Fax:210-646-6330
Practice Address - Street 1:8715 VILLAGE DR
Practice Address - Street 2:STE 400
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-5405
Practice Address - Country:US
Practice Address - Phone:210-646-6556
Practice Address - Fax:210-646-6330
Is Sole Proprietor?:No
Enumeration Date:2008-05-12
Last Update Date:2013-01-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD432010207RC0000X, 207R00000X
TXM9875207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB153127OtherWELLMED NETWORKS INC
TXB153127OtherWELLMED NETWORKS INC