Provider Demographics
NPI:1972510675
Name:OLSEN, RON ANTHON (DPM)
Entity Type:Individual
Prefix:MR
First Name:RON
Middle Name:ANTHON
Last Name:OLSEN
Suffix:
Gender:M
Credentials:DPM
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 2240
Mailing Address - Street 2:
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85142-1846
Mailing Address - Country:US
Mailing Address - Phone:520-510-3200
Mailing Address - Fax:480-655-5523
Practice Address - Street 1:20185 E OCOTILLO RD STE 105
Practice Address - Street 2:
Practice Address - City:QUEEN CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85142-7663
Practice Address - Country:US
Practice Address - Phone:480-677-3600
Practice Address - Fax:480-677-3645
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2019-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ0372213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1467564897OtherGROUP NPI
AZ1972510675OtherPROVIDER BILLING ONLY
AZ159782Medicaid
U26397Medicare UPIN
AZ1972510675OtherPROVIDER BILLING ONLY
AZ159782Medicaid