Healthcare Provider Details

I. General information

NPI: 1295791556
Provider Name (Legal Business Name): CRAIG B OLSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 09/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 NORTH MAIN
HARRISON AR
72601-2911
US

IV. Provider business mailing address

PO BOX 1893
MOUNTAIN HOME AR
72654-1893
US

V. Phone/Fax

Practice location:
  • Phone: 870-365-2244
  • Fax: 870-365-2438
Mailing address:
  • Phone: 870-424-7070
  • Fax: 870-424-6616

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberE3017
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: