Healthcare Provider Details

I. General information

NPI: 1740272210
Provider Name (Legal Business Name): DOUGLAS J OLSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/19/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SOUTHDALE RADIATION THERAPY CTR 6401 FRANCE AVE S
EDINA MN
55434
US

IV. Provider business mailing address

MPLS RADIATION ONCOLOGY 6950 FRANCE AVE S #200
EDINA MN
55435
US

V. Phone/Fax

Practice location:
  • Phone: 952-920-8477
  • Fax: 952-920-5365
Mailing address:
  • Phone: 952-920-4915
  • Fax: 952-915-6091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number24103
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: