Healthcare Provider Details

I. General information

NPI: 1699644807
Provider Name (Legal Business Name): JOHN ZOGOL JR. PRSS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2025
Last Update Date: 11/04/2025
Certification Date: 11/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

137 8TH AVE W
HUNTINGTON WV
25701-2510
US

IV. Provider business mailing address

137 8TH AVE W
HUNTINGTON WV
25701-2510
US

V. Phone/Fax

Practice location:
  • Phone: 304-408-3253
  • Fax: 304-756-8230
Mailing address:
  • Phone: 304-408-3253
  • Fax: 304-408-3253

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number259135
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: