Provider Demographics
NPI:1629272406
Name:OLSON, CRAIG HOWARD (MD)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:HOWARD
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 1:1801 INWOOD RD
Mailing Address - Street 2:STE WA4.416
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75235-7202
Mailing Address - Country:US
Mailing Address - Phone:214-505-2901
Mailing Address - Fax:
Practice Address - Street 1:1801 INWOOD RD
Practice Address - Street 2:STE WA4.416
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235-7202
Practice Address - Country:US
Practice Address - Phone:214-505-2901
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM8885208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
BP2-0019501OtherINSTITUTIONAL PERMIT