Provider Demographics
NPI:1710985197
Name:OLOMON, CAPRICE M (MD)
Entity Type:Individual
Prefix:
First Name:CAPRICE
Middle Name:M
Last Name:OLOMON
Suffix:
Gender:F
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:PO BOX 1795
Mailing Address - Street 2:
Mailing Address - City:FRASER
Mailing Address - State:CO
Mailing Address - Zip Code:80442-1795
Mailing Address - Country:US
Mailing Address - Phone:970-726-4072
Mailing Address - Fax:
Practice Address - Street 1:181 COUNTY RD 8035
Practice Address - Street 2:
Practice Address - City:FRASER
Practice Address - State:CO
Practice Address - Zip Code:80442
Practice Address - Country:US
Practice Address - Phone:970-726-4072
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-11
Last Update Date:2017-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.00364492085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO5346453AMedicare ID - Type UnspecifiedMEDICARE KC
KSB91278Medicare UPIN
KS015753Medicare ID - Type UnspecifiedKS MEDICARE