Provider Demographics
NPI:1649219601
Name:OLSON, JAMES P (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:P
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 1:1305 W 18TH ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-0401
Mailing Address - Country:US
Mailing Address - Phone:605-328-2929
Mailing Address - Fax:605-328-8429
Practice Address - Street 1:1305 W 18TH ST
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-0401
Practice Address - Country:US
Practice Address - Phone:605-328-2929
Practice Address - Fax:605-328-8429
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2012-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD4581207RC0000X
IA33742207RC0000X
MN43224207RC0000X
ND12030207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND15865Medicaid
ND15865Medicaid
NDN717316Medicare PIN
SDS101945Medicare PIN
IAI3962Medicare PIN
SDS6949Medicare PIN
SD060058452Medicare PIN
MN060001326Medicare PIN
SDP00471850Medicare PIN