Provider Demographics
NPI:1205097425
Name:OLSON, BRYON KEITH (RADIOLOGIC TECHNOLOG)
Entity type:Individual
Prefix:
First Name:BRYON
Middle Name:KEITH
Last Name:OLSON
Suffix:
Gender:M
Credentials:RADIOLOGIC TECHNOLOG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1418 14TH AVE S
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-3918
Mailing Address - Country:US
Mailing Address - Phone:701-234-0010
Mailing Address - Fax:
Practice Address - Street 1:1418 14TH AVE S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-3918
Practice Address - Country:US
Practice Address - Phone:701-234-0010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-19
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2046442471C3402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471C3402XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiography