Provider Demographics
NPI:1700195195
Name:OCRANT, IAN (MD)
Entity Type:Individual
Prefix:DR
First Name:IAN
Middle Name:
Last Name:OCRANT
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 1:377 W SPRUCE AVE
Mailing Address - Street 2:101
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93611-3303
Mailing Address - Country:US
Mailing Address - Phone:559-297-2615
Mailing Address - Fax:559-324-4207
Practice Address - Street 1:377 W SPRUCE AVE
Practice Address - Street 2:101
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93611-3303
Practice Address - Country:US
Practice Address - Phone:559-297-2615
Practice Address - Fax:559-324-4207
Is Sole Proprietor?:No
Enumeration Date:2010-10-01
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG425669208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG42569OtherCA STATE LICENSE NUMBER