Provider Demographics
NPI:1881745354
Name:OLSON, JEROLD J (MD)
Entity type:Individual
Prefix:DR
First Name:JEROLD
Middle Name:J
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:PO BOX 64307
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85728-4307
Mailing Address - Country:US
Mailing Address - Phone:520-577-9783
Mailing Address - Fax:
Practice Address - Street 1:7418 N LA CHOLLA BLVD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85741-2306
Practice Address - Country:US
Practice Address - Phone:520-731-1110
Practice Address - Fax:520-731-6582
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2013-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ23526207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ32220602OtherHEALTHCHOICE
AZ47089568785718A001OtherTRICARE
AZP00010045OtherRR MEDICARE
AZ0004337570OtherAETNA
AZ322206001OtherAPIPA
AZ47089568700OtherPACIFICARE
AZ470895687OtherUNITED HEALTH CARE
AZAZ0724550OtherBCBS
AZ1Z6468OtherHEALTHNET
AZ470895687-00OtherINDIAN HEALTH
AZ470895687OtherUNITED HEALTH CARE
AZ470895687-00OtherINDIAN HEALTH