Healthcare Provider Details

I. General information

NPI: 1073701173
Provider Name (Legal Business Name): ADAM RICHARD OLSSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2007
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11311 BRIDGEPORT WAY SW STE 309
LAKEWOOD WA
98499-3078
US

IV. Provider business mailing address

101 MED TECH PKWY STE 200
JOHNSON CITY TN
37604-4001
US

V. Phone/Fax

Practice location:
  • Phone: 253-985-2949
  • Fax: 253-274-7994
Mailing address:
  • Phone: 423-232-6120
  • Fax: 833-450-6025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberA101269
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD60321448
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberMD60321448
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: