Provider Demographics
NPI:1609849611
Name:SORRELLS, JIMMY (MD)
Entity Type:Individual
Prefix:
First Name:JIMMY
Middle Name:
Last Name:SORRELLS
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:PO BOX 180
Mailing Address - Street 2:501 N MAIN
Mailing Address - City:FINDLAY
Mailing Address - State:OH
Mailing Address - Zip Code:45839
Mailing Address - Country:US
Mailing Address - Phone:419-422-4058
Mailing Address - Fax:419-424-0553
Practice Address - Street 1:145 W WALLACE
Practice Address - Street 2:
Practice Address - City:FINDLAY
Practice Address - State:OH
Practice Address - Zip Code:45840-1239
Practice Address - Country:US
Practice Address - Phone:419-423-5324
Practice Address - Fax:419-423-5125
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35 058257207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0513180Medicaid
E39978Medicare UPIN
OH0513180Medicaid