Provider Demographics
NPI:1831108430
Name:OLSEN, MARK F (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:F
Last Name:OLSEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 W MONROE AVE STE B
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:AR
Mailing Address - Zip Code:72745-9451
Mailing Address - Country:US
Mailing Address - Phone:479-770-4100
Mailing Address - Fax:479-770-0262
Practice Address - Street 1:212 W MONROE AVE STE B
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:AR
Practice Address - Zip Code:72745-9451
Practice Address - Country:US
Practice Address - Phone:479-770-4100
Practice Address - Fax:479-770-0262
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC6864207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR731687260OtherFED TAX ID
AR51070Medicare ID - Type UnspecifiedMEDICARE NUMBER
ARD04449Medicare UPIN