Healthcare Provider Details

I. General information

NPI: 1275531865
Provider Name (Legal Business Name): ERIC G OLSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2005
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1605 G ST
SPRINGFIELD OR
97477-4227
US

IV. Provider business mailing address

1605 G ST
SPRINGFIELD OR
97477-4227
US

V. Phone/Fax

Practice location:
  • Phone: 541-741-2100
  • Fax:
Mailing address:
  • Phone: 541-741-2100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: