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General NPI Number Information
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NPI Number | 1245203058
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Entity Type | Individual
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Provider Name | ROBERT PAUL OLSON M.D.
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Gender | Male
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Dates
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Enumeration Date | 02/10/2006
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Last Update Date | 05/21/2020
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Provider Practice Location Address
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Address Line | 17000 PORTER RD STE 211
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City | WINTER GARDEN
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State | FL
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Zip | 34787-8915
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Country | US
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Telephone | 407-635-3210
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Fax | 407-636-7825
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Provider Business Mailing Address
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Address Line | 17000 PORTER RD STE 211
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City | WINTER GARDEN
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State | FL
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Zip | 34787-8915
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Country | US
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Telephone | 407-635-3210
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Fax | 407-636-7825
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 2007021133
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ME121169
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License Number State | FL
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