Healthcare Provider Details

I. General information

NPI: 1922010768
Provider Name (Legal Business Name): DAVID R OLSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 07/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2754 NC HIGHWAY 68 S STE 111
HIGH POINT NC
27265
US

IV. Provider business mailing address

PO BOX 10271
GREENSBORO NC
27404-0271
US

V. Phone/Fax

Practice location:
  • Phone: 336-802-1111
  • Fax:
Mailing address:
  • Phone: 910-728-7963
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number103691
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: