Provider Demographics
NPI:1255330775
Name:BARRY, PHILIP L (MD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:L
Last Name:BARRY
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 1:227 WEST JANSS ROAD
Mailing Address - Street 2:SUITE 320
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-1870
Mailing Address - Country:US
Mailing Address - Phone:805-497-2500
Mailing Address - Fax:805-497-2558
Practice Address - Street 1:227 W JANSS RD
Practice Address - Street 2:SUITE 320
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-1848
Practice Address - Country:US
Practice Address - Phone:805-497-2500
Practice Address - Fax:805-497-2558
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-18
Last Update Date:2010-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG20534207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ47190ZOtherBLUE SHIELD OF CALIFORNIA
953173076OtherAETNA
953173076OtherCIGNA
953173076OtherBLUE CROSS
953173076OtherBLUE SHIELD
953173076OtherUNITED
953173076OtherAARP
953173076OtherPHCS
953173076OtherCCN
953173076OtherHEALTHNET
953173076OtherCCN
953173076OtherAARP
953173076OtherBLUE CROSS