Provider Demographics
NPI:1619062916
Name:A. CHRISTOPHER OLSON, MD, PLLC
Entity Type:Organization
Organization Name:A. CHRISTOPHER OLSON, MD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:OLSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:509-489-5110
Mailing Address - Street 1:5901 N LIDGERWOOD ST
Mailing Address - Street 2:#126
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99208-5095
Mailing Address - Country:US
Mailing Address - Phone:509-489-5110
Mailing Address - Fax:509-489-2850
Practice Address - Street 1:5901 N LIDGERWOOD ST
Practice Address - Street 2:#126
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99208-5095
Practice Address - Country:US
Practice Address - Phone:509-489-5110
Practice Address - Fax:509-489-2850
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00019737174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7068141Medicaid