Healthcare Provider Details

I. General information

NPI: 1326665654
Provider Name (Legal Business Name): SAMUEL R OLSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2020
Last Update Date: 03/06/2026
Certification Date: 03/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9695 S YOSEMITE ST STE 224
LONE TREE CO
80124-2890
US

IV. Provider business mailing address

9695 S YOSEMITE ST STE 224
LONE TREE CO
80124-2890
US

V. Phone/Fax

Practice location:
  • Phone: 303-265-3970
  • Fax:
Mailing address:
  • Phone: 303-265-3970
  • Fax: 303-265-3971

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number57.253139
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberDR.0075884
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: