MEDICARE: MR. LARRY TODD OLSEN DO

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	4132	OK

Other Identifiers

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

General Provider Information

NPI Number	:	1942281027
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. LARRY TODD OLSEN DO

Provider Business Mailing Address
First Line	:	3400 S DOUGLAS BLVD
Second Line	:	302
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73150
Country	:	US
Telephone Number	:	405-733-8000
Fax Number	:	405-733-7820

Provider Business Practice Location Address
First Line	:	3400 S DOUGLAS BLVD
Second Line	:	302
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73150
Country	:	US
Telephone Number	:	405-733-8000
Fax Number	:	405-733-7820

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

Provider Enumeration Date	:	11/07/2005
Last Update Date	:	02/11/2015

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