Provider Demographics
NPI:1386698280
Name:DEBOARD, RYAN HAL (MD)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:HAL
Last Name:DEBOARD
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 1:34322 BACIO DIVINO CT
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92592-5568
Mailing Address - Country:US
Mailing Address - Phone:951-303-3060
Mailing Address - Fax:
Practice Address - Street 1:25500 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-5965
Practice Address - Country:US
Practice Address - Phone:951-696-6161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2013-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA115412207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine