Provider Demographics
NPI:1942287149
Name:COOK, BARRY ALAN (MD)
Entity Type:Individual
Prefix:
First Name:BARRY
Middle Name:ALAN
Last Name:COOK
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 1:810 N ROSE AVE
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-4944
Mailing Address - Country:US
Mailing Address - Phone:407-518-3565
Mailing Address - Fax:407-518-3646
Practice Address - Street 1:700 W OAK ST
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-4924
Practice Address - Country:US
Practice Address - Phone:407-518-3565
Practice Address - Fax:407-518-3646
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME58860207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL276106800Medicaid
FLE63464Medicare UPIN
FL276106800Medicaid