Provider Demographics
NPI:1578901492
Name:OLSON, JUDITH ELINOR (MD)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:ELINOR
Last Name:OLSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JUDITH
Other - Middle Name:GRANQUIST
Other - Last Name:OLSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1430 TROTTING HORSE LN
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59804-5806
Mailing Address - Country:US
Mailing Address - Phone:406-728-6023
Mailing Address - Fax:406-728-6023
Practice Address - Street 1:1430 TROTTING HORSE LN
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59804-5806
Practice Address - Country:US
Practice Address - Phone:406-728-6023
Practice Address - Fax:406-728-6023
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-13
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT3674207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine