MEDICARE: DR. PATRICK R 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
1	207X00000X	Orthopaedic Surgery Physician	351722-1205	UT

General Provider Information

NPI Number	:	1811095326
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PATRICK R OLSON M.D.

Provider Business Mailing Address
First Line	:	900 ROUND VALLEY DR
Second Line	:	STE 100
City	:	PARK CITY
State	:	UT
Zip	:	84060-7552
Country	:	US
Telephone Number	:	801-314-5025
Fax Number	:	801-314-4015

Provider Business Practice Location Address
First Line	:	5848 S FASHION BLVD STE 110
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84107-6121
Country	:	US
Telephone Number	:	801-314-5025
Fax Number	:	801-314-4015

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	06/07/2017

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