Provider Demographics
NPI:1245203058
Name:OLSON, ROBERT PAUL (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:PAUL
Last Name:OLSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:17000 PORTER RD STE 211
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-8915
Mailing Address - Country:US
Mailing Address - Phone:407-635-3210
Mailing Address - Fax:407-636-7825
Practice Address - Street 1:17000 PORTER RD STE 211
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-8915
Practice Address - Country:US
Practice Address - Phone:407-635-3210
Practice Address - Fax:407-636-7825
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2007021133207Q00000X
FLME121169207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL012976800Medicaid
MOP01222570OtherRR MCR
MO431560263OtherTRICARE
MO1245203085Medicaid
MO431560263OtherTRICARE
MO1245203085Medicaid