Provider Demographics
NPI:1376618397
Name:OLSEN, DOUGLAS OLE (MD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:OLE
Last Name:OLSEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3024 BUSINESS PARK CIR
Mailing Address - Street 2:
Mailing Address - City:GOODLETTSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37072-3132
Mailing Address - Country:US
Mailing Address - Phone:615-851-6033
Mailing Address - Fax:615-851-2018
Practice Address - Street 1:2200 MURPHY AVE
Practice Address - Street 2:SUITE B
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-1826
Practice Address - Country:US
Practice Address - Phone:615-342-5840
Practice Address - Fax:615-342-5845
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN16968208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN6032482OtherBCBS TN
TNA98450Medicare UPIN
TN103I021012Medicare PIN