Healthcare Provider Details

I. General information

NPI: 1720178775
Provider Name (Legal Business Name): TERRY S OLSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 11/01/2020
Certification Date: 11/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 N FLAGLER DR STE 920
WEST PALM BEACH FL
33401-3432
US

IV. Provider business mailing address

900 NW 13TH STREET SUITE 206
BOCA RATON FL
33486
US

V. Phone/Fax

Practice location:
  • Phone: 561-659-2266
  • Fax: 561-659-7846
Mailing address:
  • Phone: 561-338-3267
  • Fax: 561-391-4420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number18366
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberME122440
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: