Provider Demographics
NPI:1336120641
Name:SELL, BARRY J (MD)
Entity Type:Individual
Prefix:DR
First Name:BARRY
Middle Name:J
Last Name:SELL
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 1:13740 CYPRESS TERRACE CIR
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-8827
Mailing Address - Country:US
Mailing Address - Phone:239-275-5522
Mailing Address - Fax:239-275-4464
Practice Address - Street 1:1255 VISCAYA PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33990-3290
Practice Address - Country:US
Practice Address - Phone:239-574-1988
Practice Address - Fax:239-574-1435
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-14
Last Update Date:2010-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME24747207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL71844OtherBC/BS OF FLORIDA
FL051453500Medicaid
FL203816OtherAVMED
FL000013683GOtherHUMANA
FL16061OtherSTAYWELL
FL051453500Medicaid
FL203816OtherAVMED