Provider Demographics
NPI:1134285570
Name:COGEN, BARRY MATTHEW (DO)
Entity Type:Individual
Prefix:DR
First Name:BARRY
Middle Name:MATTHEW
Last Name:COGEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2772 JOHNSON DR
Mailing Address - Street 2:SUITE 114
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-8582
Mailing Address - Country:US
Mailing Address - Phone:805-644-3311
Mailing Address - Fax:
Practice Address - Street 1:2772 JOHNSON DR
Practice Address - Street 2:SUITE 114
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-8582
Practice Address - Country:US
Practice Address - Phone:805-644-3311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A5574207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE08917Medicare UPIN