Provider Demographics
NPI:1376626853
Name:SAMPSON, JOHN ARGYLE (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ARGYLE
Last Name:SAMPSON
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 1:5529 BROWNS LAKE
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49203
Mailing Address - Country:US
Mailing Address - Phone:517-789-9968
Mailing Address - Fax:
Practice Address - Street 1:1514 4TH ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49203-4032
Practice Address - Country:US
Practice Address - Phone:517-780-0080
Practice Address - Fax:517-780-0043
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301JS049181174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI13-20001OtherPHP
MI24-0380695-2OtherBLUE CROSS
MI13-20001OtherPHP
MIE19852Medicare UPIN