Healthcare Provider Details

I. General information

NPI: 1942279104
Provider Name (Legal Business Name): DAVID S OLSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2006
Last Update Date: 10/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2881 HYDE PARK ST SECOND FLOOR
SARASOTA FL
34239-3228
US

IV. Provider business mailing address

2881 HYDE PARK ST SECOND FLOOR
SARASOTA FL
34239-3228
US

V. Phone/Fax

Practice location:
  • Phone: 941-366-2460
  • Fax: 941-366-3015
Mailing address:
  • Phone: 941-366-2460
  • Fax: 941-366-3015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME30775
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: