Provider Demographics
NPI:1174025647
Name:POLSTON, RYAN WILLIAM (MD)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:WILLIAM
Last Name:POLSTON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3551 ROGER BROOKE DR
Mailing Address - Street 2:
Mailing Address - City:JBSA FT SAM HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:78234-4504
Mailing Address - Country:US
Mailing Address - Phone:210-916-2153
Mailing Address - Fax:210-916-0709
Practice Address - Street 1:3551 ROGER BROOKE DR
Practice Address - Street 2:
Practice Address - City:JBSA FT SAM HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:78234-4504
Practice Address - Country:US
Practice Address - Phone:210-916-2153
Practice Address - Fax:210-916-0709
Is Sole Proprietor?:No
Enumeration Date:2018-03-01
Last Update Date:2025-10-03
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Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WA61227551207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine