Provider Demographics
NPI:1346218948
Name:OLSON, MARK C (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:C
Last Name:OLSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 W 5TH AVE
Mailing Address - Street 2:STE 400
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204-2705
Mailing Address - Country:US
Mailing Address - Phone:509-344-2663
Mailing Address - Fax:509-624-9179
Practice Address - Street 1:601 W 5TH AVE
Practice Address - Street 2:STE 400
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2705
Practice Address - Country:US
Practice Address - Phone:509-344-2663
Practice Address - Fax:509-624-9179
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00013246207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA379109600OtherOWCP
WA8929872OtherCRIME VICTIMS
ID0000101463343OtherREGENCE BLUE SHIELD OF ID
WAOL3345OtherASURIS NW HEALTH
WA0261186OtherSTATE L&I
WA1651207Medicaid
WA513OtherGROUP HEALTH NW
WA200040946OtherRR MEDICARE
IDKQ530OtherBLUE CROSS OF IDAHO
ID000010146343OtherREGENCE BLUE SHIELD OF ID
ID003864700IMedicaid
MT0072641Medicaid
WA149065OtherDEPT OF LABOR & INDUSTRIE
WA513OtherGROUP HEALTH NW
IDKQ530OtherBLUE CROSS OF IDAHO
A07338Medicare UPIN
WAAB21406Medicare ID - Type Unspecified