Healthcare Provider Details

I. General information

NPI: 1164471496
Provider Name (Legal Business Name): JAMES R. OLFSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2821 E PRESIDENT GEORGE BUSH HWY STE 100
RICHARDSON TX
75082-4266
US

IV. Provider business mailing address

2821 E PRESIDENT GEORGE BUSH HWY STE 100
RICHARDSON TX
75082-4266
US

V. Phone/Fax

Practice location:
  • Phone: 214-575-3422
  • Fax: 214-575-9929
Mailing address:
  • Phone: 214-575-3422
  • Fax: 214-575-9929

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberK6198
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: