Provider Demographics
NPI:1861643215
Name:IAN BARE MD, INC.
Entity type:Organization
Organization Name:IAN BARE MD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:IAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BARE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-997-8911
Mailing Address - Street 1:PO BOX 2365
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92690-0365
Mailing Address - Country:US
Mailing Address - Phone:714-997-8911
Mailing Address - Fax:714-997-4911
Practice Address - Street 1:805 W LA VETA AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-3901
Practice Address - Country:US
Practice Address - Phone:714-997-8911
Practice Address - Fax:714-997-4911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-03
Last Update Date:2008-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA80711207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty