Provider Demographics
NPI:1801335328
Name:OLSON, JEFFREY WAYNE (MD)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:WAYNE
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 1:7555 FAIRVIEW DR
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:IN
Mailing Address - Zip Code:47630-3057
Mailing Address - Country:US
Mailing Address - Phone:812-853-2743
Mailing Address - Fax:
Practice Address - Street 1:7555 FAIRVIEW DR
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:IN
Practice Address - Zip Code:47630-3057
Practice Address - Country:US
Practice Address - Phone:812-853-2743
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-16
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01025425A207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology