Provider Demographics
NPI:1861476137
Name:RANON, ERIC BANTAYAN (MD)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:BANTAYAN
Last Name:RANON
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:PO BOX 776084
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6084
Mailing Address - Country:US
Mailing Address - Phone:314-543-6979
Mailing Address - Fax:314-364-6321
Practice Address - Street 1:3801 W FINANCIAL PKWY STE 102
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-1499
Practice Address - Country:US
Practice Address - Phone:479-877-7780
Practice Address - Fax:479-877-7781
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-18274207R00000X
FLME92650207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL272227500Medicaid
I39733Medicare UPIN