Healthcare Provider Details

I. General information

NPI: 1134127087
Provider Name (Legal Business Name): THOMAS HARRY OLSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2005
Last Update Date: 05/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 E MAIN ST
VERMILLION SD
57069-0277
US

IV. Provider business mailing address

PO BOX 277
VERMILLION SD
57069-0277
US

V. Phone/Fax

Practice location:
  • Phone: 605-624-5666
  • Fax: 605-624-2984
Mailing address:
  • Phone: 605-624-5666
  • Fax: 605-624-2984

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2237
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: