Provider Demographics
NPI:1740272210
Name:OLSON, DOUGLAS J (MD)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:J
Last Name:OLSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:MPLS RADIATION ONCOLOGY
Mailing Address - Street 2:6950 FRANCE AVE S #200
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435
Mailing Address - Country:US
Mailing Address - Phone:952-920-4915
Mailing Address - Fax:952-915-6091
Practice Address - Street 1:SOUTHDALE RADIATION THERAPY CTR
Practice Address - Street 2:6401 FRANCE AVE S
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55434
Practice Address - Country:US
Practice Address - Phone:952-920-8477
Practice Address - Fax:952-920-5365
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN241032085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN2409880OtherMEDICA
MN963070250002OtherPREFERRED ONE
MN104834OtherUCARE
MN105691OtherCHOICE PLUS
ND12379Medicaid
MN12840OLOtherBLUE CROSS/BLUE SHIELD
MN25135OtherAMERICA'S PPO
MNHP14103OtherHEALTH PARTNERS
WI30624000Medicaid
MN2400004OtherMEDICA PRIMARY
ND12379Medicaid