Provider Demographics
NPI:1245439553
Name:OLSON, TERRENCE JOSEPH (MD)
Entity type:Individual
Prefix:DR
First Name:TERRENCE
Middle Name:JOSEPH
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 1:200 SW MARKET ST
Mailing Address - Street 2:EAST 9 A
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97201-5715
Mailing Address - Country:US
Mailing Address - Phone:503-414-7818
Mailing Address - Fax:503-225-4882
Practice Address - Street 1:200 SW MARKET ST
Practice Address - Street 2:EAST 9 A
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97201-5715
Practice Address - Country:US
Practice Address - Phone:503-414-7818
Practice Address - Fax:503-225-4882
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-16
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR18040305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORBO2206703OtherDEA