Provider Demographics
NPI:1831285451
Name:OLSON, DAVID MARK (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:MARK
Last Name:OLSON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1898 FORT ROAD
Mailing Address - Street 2:SHERIDAN VAMC
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801
Mailing Address - Country:US
Mailing Address - Phone:307-672-3473
Mailing Address - Fax:307-672-1911
Practice Address - Street 1:1898 FORT ROAD
Practice Address - Street 2:SHERIDAN VAMC
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801
Practice Address - Country:US
Practice Address - Phone:307-672-3473
Practice Address - Fax:307-672-1911
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXH73332084P0800X
CO345592084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
F79768Medicare UPIN