Provider Demographics
NPI:1609876366
Name:COOPER, BARRY J (MD)
Entity Type:Individual
Prefix:DR
First Name:BARRY
Middle Name:J
Last Name:COOPER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1139 CONWYCK LN
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63131-2630
Mailing Address - Country:US
Mailing Address - Phone:314-842-5252
Mailing Address - Fax:314-842-1524
Practice Address - Street 1:10004 KENNERLY RD
Practice Address - Street 2:#180B
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-2141
Practice Address - Country:US
Practice Address - Phone:314-842-5252
Practice Address - Fax:314-842-1524
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-26
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
MO34574207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
C51528Medicare UPIN