Provider Demographics
NPI:1417053059
Name:MARY L. OLSEN, M.D., P.A.
Entity Type:Organization
Organization Name:MARY L. OLSEN, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:L
Authorized Official - Last Name:OLSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:409-832-9600
Mailing Address - Street 1:3070 COLLEGE ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77701-4691
Mailing Address - Country:US
Mailing Address - Phone:409-832-9600
Mailing Address - Fax:409-832-9610
Practice Address - Street 1:3070 COLLEGE ST
Practice Address - Street 2:SUITE 205
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77701-4691
Practice Address - Country:US
Practice Address - Phone:409-832-9600
Practice Address - Fax:409-832-9610
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00159XMedicare ID - Type UnspecifiedMEDICARE NUMBER