Healthcare Provider Details

I. General information

NPI: 1962412767
Provider Name (Legal Business Name): SPENCER SHIRL OLSEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5575 RUFFIN ROAD US HEALTH WORKS SUITE 100
SAN DIEGO CA
92123-1361
US

IV. Provider business mailing address

1800 E SHELBY ST
SEATTLE WA
98112
US

V. Phone/Fax

Practice location:
  • Phone: 858-565-1300
  • Fax: 858-565-6932
Mailing address:
  • Phone: 206-852-8661
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License NumberA88450
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: