Healthcare Provider Details

I. General information

NPI: 1902565930
Provider Name (Legal Business Name): ROBERT OLSEN MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2021
Last Update Date: 01/03/2024
Certification Date: 01/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13535 SW 72ND AVE STE 170
PORTLAND OR
97223-8074
US

IV. Provider business mailing address

13535 SW 72ND AVE STE 170
PORTLAND OR
97223-8074
US

V. Phone/Fax

Practice location:
  • Phone: 971-300-0654
  • Fax:
Mailing address:
  • Phone: 971-300-0654
  • Fax: 720-881-9063

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: ROBERT OLSEN
Title or Position: OWNER
Credential: MD
Phone: 971-202-5140