Provider Demographics
NPI:1831334861
Name:OLSON, JOSHUA ROBERT (MD)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:ROBERT
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 1:1482 E WILLIAMS FIELD RD
Mailing Address - Street 2:SUITE B101
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-1816
Mailing Address - Country:US
Mailing Address - Phone:480-466-7355
Mailing Address - Fax:480-939-2751
Practice Address - Street 1:1482 E WILLIAMS FIELD RD
Practice Address - Street 2:SUITE B101
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-1816
Practice Address - Country:US
Practice Address - Phone:480-466-7355
Practice Address - Fax:480-939-2751
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-04
Last Update Date:2016-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ474932086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ161154Medicare UPIN