Healthcare Provider Details

I. General information

NPI: 1962895367
Provider Name (Legal Business Name): DEVIN G OLSEN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2015
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 N SWITZER CANYON DR
FLAGSTAFF AZ
86001-4845
US

IV. Provider business mailing address

525 N SWITZER CANYON DR
FLAGSTAFF AZ
86001-4845
US

V. Phone/Fax

Practice location:
  • Phone: 928-773-2280
  • Fax: 928-773-2281
Mailing address:
  • Phone: 928-773-2280
  • Fax: 928-773-2281

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberOS019621
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberH94086
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number012590
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: