Provider Demographics
NPI:1730303090
Name:OLSON, JUNE ANN (MD)
Entity Type:Individual
Prefix:
First Name:JUNE
Middle Name:ANN
Last Name:OLSON
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 955
Mailing Address - Street 2:
Mailing Address - City:WELCHES
Mailing Address - State:OR
Mailing Address - Zip Code:97067-0955
Mailing Address - Country:US
Mailing Address - Phone:503-674-1129
Mailing Address - Fax:503-674-1144
Practice Address - Street 1:24800 SE STARK ST
Practice Address - Street 2:MOUNT HOOD MEDICAL CENTER, LABORATORY
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-3378
Practice Address - Country:US
Practice Address - Phone:503-674-1129
Practice Address - Fax:503-674-1144
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD 16719207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR109518Medicare ID - Type Unspecified