Provider Demographics
NPI:1215060736
Name:CONCOOL, BARRY M (MD)
Entity type:Individual
Prefix:
First Name:BARRY
Middle Name:M
Last Name:CONCOOL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:5101 NORTH DAVIS HWY
Mailing Address - Street 2:SUITE B
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-2040
Mailing Address - Country:US
Mailing Address - Phone:850-438-1277
Mailing Address - Fax:850-497-6219
Practice Address - Street 1:5101 NORTH DAVIS HWY
Practice Address - Street 2:SUITE B
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-2040
Practice Address - Country:US
Practice Address - Phone:850-438-1277
Practice Address - Fax:850-497-6219
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2015-10-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PA033155E207W00000X
NJ25MA04568500207W00000X
FLME38137207W00000X
CT053554207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL25763OtherBCBS-FLORIDA
PA0021912000OtherPERSONAL CHOICE
NJ051446CJPOtherNJ MEDICARE
NJ223708906OtherHORIZON
CTD400184414Medicare PIN
FL25763OtherBCBS-FLORIDA
B34086Medicare UPIN
B34086Medicare UPIN
FL25763Medicare PIN