Healthcare Provider Details

I. General information

NPI: 1346153210
Provider Name (Legal Business Name): RYAN STEVEN DUBOSE MS, DABR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 WILD IRIS DR
MYRTLE BEACH SC
29577-8867
US

IV. Provider business mailing address

4600 WILD IRIS DR
MYRTLE BEACH SC
29577-8867
US

V. Phone/Fax

Practice location:
  • Phone: 843-687-2748
  • Fax:
Mailing address:
  • Phone: 843-687-2748
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberP4715
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: