Provider Demographics
NPI:1457580623
Name:DONALD R OLSON, MD, FACS, LLC
Entity Type:Organization
Organization Name:DONALD R OLSON, MD, FACS, LLC
Other - Org Name:DONALD OLSON, MD, FACS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BETH ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:PAINERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-885-1188
Mailing Address - Street 1:6464 SW BORLAND RD
Mailing Address - Street 2:SUITE A2
Mailing Address - City:TUALATIN
Mailing Address - State:OR
Mailing Address - Zip Code:97062-8876
Mailing Address - Country:US
Mailing Address - Phone:503-885-1188
Mailing Address - Fax:503-885-1180
Practice Address - Street 1:6464 SW BORLAND RD
Practice Address - Street 2:SUITE A2
Practice Address - City:TUALATIN
Practice Address - State:OR
Practice Address - Zip Code:97062-8876
Practice Address - Country:US
Practice Address - Phone:503-885-1188
Practice Address - Fax:503-885-1180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-09
Last Update Date:2009-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD14697174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty