Provider Demographics
NPI:1669458469
Name:DRANOFF, JONATHAN A (MD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:A
Last Name:DRANOFF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4301 W MARKHAM ST # 567
Mailing Address - Street 2:SHOREY S8/68
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-7101
Mailing Address - Country:US
Mailing Address - Phone:501-688-7840
Mailing Address - Fax:501-688-6248
Practice Address - Street 1:4301 W MARKHAM ST # 567
Practice Address - Street 2:SHOREY S8/68
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-7101
Practice Address - Country:US
Practice Address - Phone:501-688-7840
Practice Address - Fax:501-688-6248
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT037326207RG0100X
ARE-6907207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001373266Medicaid
CT110008301Medicare ID - Type Unspecified
H40112Medicare UPIN
AR5AJ16Medicare PIN