Provider Demographics
NPI:1174841795
Name:OLSON, GREGORY T (DO)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:T
Last Name:OLSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:814 PIERCE ST
Mailing Address - Street 2:STE 300
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51101-1058
Mailing Address - Country:US
Mailing Address - Phone:712-226-2600
Mailing Address - Fax:712-226-2605
Practice Address - Street 1:4545 SERGEANT RD
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51106-4706
Practice Address - Country:US
Practice Address - Phone:712-274-2400
Practice Address - Fax:712-274-1487
Is Sole Proprietor?:No
Enumeration Date:2010-05-06
Last Update Date:2014-11-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IA4203207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine