Individual
JEROME M SAMPSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3000 32ND AVE S, FARGO, ND 58103-6132
(701) 364-8000
(701) 364-8078
Mailing address
PO BOX 6001, FARGO, ND 58108-6001
(701) 364-3300
(701) 364-8906
Taxonomy
Speciality
Code
Description
License number
State
2085N0700X
Neuroradiology Physician
4703
ND
2085R0202X
Diagnostic Radiology Physician
Primary
4703
ND
2085R0204X
Vascular & Interventional Radiology Physician
4703
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
14146
—
ND
01
—
1600852
MEDICA FGO #
ND
01
—
1600853
MEDICA INN #
ND
05
—
634208600
—
ND
01
—
676650
ARAZ #
ND
01
—
91427SA
MNBS #
ND
01
—
9258
SIOUX VALLEY PROV #
ND
01
—
974
NDBS #
ND
01
—
DA9011015581
PREF 1 #
ND
01
—
HP25764
HEALTHPARTNERS #
ND
Enumeration date
06/26/2006
Last updated
07/18/2012
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