Provider Demographics
NPI:1275524696
Name:OLSON, KENT RUSSELL (MD)
Entity Type:Individual
Prefix:
First Name:KENT
Middle Name:RUSSELL
Last Name:OLSON
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:POISON CONTROL CTR
Mailing Address - Street 2:UCSF BOX 1369
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94143-1369
Mailing Address - Country:US
Mailing Address - Phone:415-502-6002
Mailing Address - Fax:
Practice Address - Street 1:POISON CONTROL CTR
Practice Address - Street 2:UCSF BOX 1369
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94143-1369
Practice Address - Country:US
Practice Address - Phone:415-502-6002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG39696207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G396960Medicaid
CA00G396960OtherBLUE SHIELD
CA00G396960Medicare ID - Type Unspecified
CA00G396960Medicaid