Provider Demographics
NPI:1184613101
Name:OLSON, LOREN A (MD, DLFAPA)
Entity type:Individual
Prefix:DR
First Name:LOREN
Middle Name:A
Last Name:OLSON
Suffix:
Gender:M
Credentials:MD, DLFAPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2213 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50312-5305
Mailing Address - Country:US
Mailing Address - Phone:515-237-3974
Mailing Address - Fax:515-883-2692
Practice Address - Street 1:4908 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50310-1901
Practice Address - Country:US
Practice Address - Phone:515-280-4930
Practice Address - Fax:515-309-0686
Is Sole Proprietor?:No
Enumeration Date:2005-10-21
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA219412084P0800X
MO20210038932084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA102269OtherVALUE OPTIONS
IA1184613101OtherWELLMARK BCBS
IA1184613101Medicaid
IA1184613101Medicaid
IA42128OtherWELLMARK BLUE SHIELD
IA1184613101Medicaid
IA102269OtherVALUE OPTIONS
IAI3970Medicare ID - Type UnspecifiedMEDICARE
IAIA0104OtherDEERE
IA42128OtherFIRST ADMINISTRATORS