Healthcare Provider Details

I. General information

NPI: 1285193540
Provider Name (Legal Business Name): ROBERT CHRISTIAN LEE OLSON DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2019
Last Update Date: 06/30/2023
Certification Date: 06/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

GRAND STRAND MEDICAL CENTER 809 82ND PKWY
MYRTLE BEACH SC
29572
US

IV. Provider business mailing address

GRAND STRAND MEDICAL CENTER 809 82ND PKWY
MYRTLE BEACH SC
29572
US

V. Phone/Fax

Practice location:
  • Phone: 843-847-4377
  • Fax:
Mailing address:
  • Phone: 843-847-4377
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number89532
License Number StateSC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: