Provider Demographics
NPI:1568717262
Name:OLSON, SHAWN PHILLIP (MD)
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:PHILLIP
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 1:501 N COLUMBIA RD STOP 9037
Mailing Address - Street 2:DEPT OF SURGERY RM 5107,UNIVERSITY OF NORTH DAKOTA SMHS
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58202-9037
Mailing Address - Country:US
Mailing Address - Phone:701-777-3067
Mailing Address - Fax:701-777-2609
Practice Address - Street 1:501 N COLUMBIA RD STOP 9037
Practice Address - Street 2:DEPT OF SURGERY RM 5107,UNIVERSITY OF NORTH DAKOTA SMHS
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58202-9037
Practice Address - Country:US
Practice Address - Phone:701-777-3067
Practice Address - Fax:701-777-2609
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-18
Last Update Date:2012-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDTRL 12384208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery