Provider Demographics
NPI:1679834121
Name:OLSON, JOSEPH ANDEW (DO)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:ANDEW
Last Name:OLSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14721 WHITECAP BLVD APT 264
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78418-7722
Mailing Address - Country:US
Mailing Address - Phone:361-331-6897
Mailing Address - Fax:
Practice Address - Street 1:1711 W WHEELER AVE
Practice Address - Street 2:
Practice Address - City:ARANSAS PASS
Practice Address - State:TX
Practice Address - Zip Code:78336-4536
Practice Address - Country:US
Practice Address - Phone:361-758-8585
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-31
Last Update Date:2014-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP3048207P00000X
MN57284207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NDH400120506Medicare PIN
NDH400120508Medicare PIN