Provider Demographics
NPI:1467423087
Name:OLSON, GRANT C (MD)
Entity Type:Individual
Prefix:DR
First Name:GRANT
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 - Credentials:
Mailing Address - Street 1:1667 COLE BLVD
Mailing Address - Street 2:BLDG 19, SUITE 200
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80401-3300
Mailing Address - Country:US
Mailing Address - Phone:303-420-3131
Mailing Address - Fax:303-420-1984
Practice Address - Street 1:125 RAMPART WAY
Practice Address - Street 2:SUITE 200
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80230-6406
Practice Address - Country:US
Practice Address - Phone:720-858-7600
Practice Address - Fax:720-858-7605
Is Sole Proprietor?:No
Enumeration Date:2006-01-31
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO27491174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01274919Medicaid
COC18694Medicare PIN
COF33664Medicare UPIN