Provider Demographics
NPI:1902867609
Name:OLSON, DAVID EDWIN SR (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:EDWIN
Last Name:OLSON
Suffix:SR
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:PO BOX 7600
Mailing Address - Street 2:
Mailing Address - City:YANKTON
Mailing Address - State:SD
Mailing Address - Zip Code:57078-7600
Mailing Address - Country:US
Mailing Address - Phone:320-224-4959
Mailing Address - Fax:605-668-3460
Practice Address - Street 1:3515 BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:YANKTON
Practice Address - State:SD
Practice Address - Zip Code:57078-7600
Practice Address - Country:US
Practice Address - Phone:605-668-3100
Practice Address - Fax:605-668-3460
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN202992084P0800X
SD79132084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN506080000Medicaid
MN506080000Medicaid
260001690Medicare ID - Type Unspecified