Provider Demographics
NPI:1871512509
Name:OLSON, ERIC LAWRENCE (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:LAWRENCE
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 1:3000 N GARFIELD ST STE 105
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79705-6417
Mailing Address - Country:US
Mailing Address - Phone:432-620-0161
Mailing Address - Fax:432-620-0166
Practice Address - Street 1:3000 N GARFIELD ST STE 105
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79705-6417
Practice Address - Country:US
Practice Address - Phone:432-620-0161
Practice Address - Fax:432-620-0166
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2010-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH45862084P0800X, 2084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX135335106Medicaid
TXE12514Medicare UPIN
TX0064BUMedicare ID - Type Unspecified