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NPI Code Detail

MEDICARE: DR. KEVIN DONALD OLSON M.D.

MEDICARE: DR. KEVIN DONALD OLSON M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207RH0000XHematology (Internal Medicine) PhysicianMD17386OR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1407859184
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KEVIN DONALD OLSON M.D.
Provider Business Mailing Address
First Line : 19260 SW 65TH AVE
Second Line : STE 435
City : TUALATIN
State : OR
Zip : 97062-7707
Country : US
Telephone Number : 503-692-2032
Fax Number : 503-692-4450
Provider Business Practice Location Address
First Line : 19260 SW 65TH AVE
Second Line : STE 435
City : TUALATIN
State : OR
Zip : 97062-7707
Country : US
Telephone Number : 503-692-2032
Fax Number : 503-692-4450
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/24/2005
Last Update Date : 12/22/2011

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