Provider Demographics
NPI:1720178775
Name:OLSON, TERRY S (MD)
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:S
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 1:900 NW 13TH STREET
Mailing Address - Street 2:SUITE 206
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33486
Mailing Address - Country:US
Mailing Address - Phone:561-338-3267
Mailing Address - Fax:561-391-4420
Practice Address - Street 1:1515 N FLAGLER DR STE 920
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-3432
Practice Address - Country:US
Practice Address - Phone:561-659-2266
Practice Address - Fax:561-659-7846
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2020-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE18366207Y00000X
FLME122440207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NEE88488Medicare UPIN
NE090218Medicare ID - Type Unspecified