Healthcare Provider Details

I. General information

NPI: 1366434912
Provider Name (Legal Business Name): MICHAEL JAY SOMPLE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2005
Last Update Date: 08/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

751 FOREST AVE SUITE 400
ZANESVILLE OH
43701-2868
US

IV. Provider business mailing address

751 FOREST AVE SUITE 400
ZANESVILLE OH
43701-2868
US

V. Phone/Fax

Practice location:
  • Phone: 740-452-4053
  • Fax: 740-452-4580
Mailing address:
  • Phone: 740-452-4053
  • Fax: 740-452-4580

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number35046011S
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code2085D0003X
TaxonomyDiagnostic Neuroimaging (Radiology) Physician
License Number35046011
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: