Healthcare Provider Details

I. General information

NPI: 1730303090
Provider Name (Legal Business Name): JUNE ANN OLSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24800 SE STARK ST MOUNT HOOD MEDICAL CENTER, LABORATORY
GRESHAM OR
97030-3378
US

IV. Provider business mailing address

PO BOX 955
WELCHES OR
97067-0955
US

V. Phone/Fax

Practice location:
  • Phone: 503-674-1129
  • Fax: 503-674-1144
Mailing address:
  • Phone: 503-674-1129
  • Fax: 503-674-1144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberMD 16719
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: