Individual provider Active NPI

Bry Henry Coburn, MD

  • Ophthalmology Physician
  • Birmingham, AL
National Provider Identifier
1831171024
Registry record updated May 6, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
License
5794 Issued in AL
Practice address
833 Saint Vincents Dr
Ste 207 Pob 3
Birmingham, AL 35205-1606
Phone
(205) 933-1380
Fax
(205) 930-9222
NPI assigned
Nov 15, 2005
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 6, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology Physician 207W00000X 5794 AL Primary

Addresses

Primary practice location

833 Saint Vincents Dr
Ste 207 Pob 3
Birmingham, AL 35205-1606

Mailing address

833 Saint Vincents Dr
Ste 207 Pob 3
Birmingham, AL 35205-1606
Phone (205) 933-1380

Other identifiers 1

IdentifierTypeStateIssuer
1831171024MedicaidAL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
5794ALMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
DRS Turnbull & Coburn PC PastSince Sep 28, 1994 Accepting new patients
Kenneth R. Smith, P.C. Ophthalmology PastSince Aug 10, 2009 Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1132012800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1210032000000",
    "number": "1831171024",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "833 SAINT VINCENTS DR",
            "address_2": "STE 207 POB 3",
            "city": "BIRMINGHAM",
            "state": "AL",
            "postal_code": "352051606",
            "telephone_number": "205-933-1380",
            "fax_number": "205-930-9222"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "833 SAINT VINCENTS DR",
            "address_2": "STE 207 POB 3",
            "city": "BIRMINGHAM",
            "state": "AL",
            "postal_code": "352051606",
            "telephone_number": "205-933-1380",
            "fax_number": "205-930-9222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COBURN",
        "first_name": "BRY",
        "middle_name": "HENRY",
        "name_prefix": "Mr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-11-15",
        "last_updated": "2008-05-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "AL",
            "license": "5794",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1831171024",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Birmingham, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.