Individual
BARRY JOHN COUGHLIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD FACC
Contact information
Practice address
136 NORTH THIRD ST STE 1, LOMPOC, CA 93436
(805) 735-7771
(805) 735-9911
Mailing address
PO BOX 567, LOMPOC, CA 93438
(805) 736-1875
(805) 735-9911
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
C31374
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00C313740
—
CA
01
—
ZZZ38994Z
BLUE SHIELD OF CALIFORNIA
CA
Enumeration date
12/20/2005
Last updated
04/22/2008
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