Provider Demographics
NPI:1114073913
Name:COLE, BARRY ELIOT (MD)
Entity Type:Individual
Prefix:
First Name:BARRY
Middle Name:ELIOT
Last Name:COLE
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 1:10035 CLAVERTON CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-4769
Mailing Address - Country:US
Mailing Address - Phone:702-497-2235
Mailing Address - Fax:917-551-6605
Practice Address - Street 1:10035 CLAVERTON CT
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148
Practice Address - Country:US
Practice Address - Phone:702-497-2235
Practice Address - Fax:917-551-6605
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2014-05182084P0800X
HIMD-115692084P2900X, 2084N0400X
ALMD307992084P2900X, 2084P0800X
CAG-460282084P0800X
AZ487232084P0800X
ARR-41452084P0800X
NV53722084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPain Medicine
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI0000237297OtherHMSA BILLING NUMBER
HI517732-03Medicaid
HI0000237297OtherHMSA BILLING NUMBER
HIC83295Medicare UPIN