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General NPI Number Information
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NPI Number | 1306936794
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Entity Type | Individual
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Provider Name | ALAN D OLMSTEAD
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Gender | Male
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Dates
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Enumeration Date | 10/13/2006
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Last Update Date | 12/05/2018
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Provider Practice Location Address
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Address Line | 844 WASHINGTON ST N STE 100
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City | TWIN FALLS
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State | ID
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Zip | 83301
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Country | US
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Telephone | 208-734-6800
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Fax | 208-735-1635
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Provider Business Mailing Address
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Address Line | 844 WASHINGTON ST N STE 100
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City | TWIN FALLS
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State | ID
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Zip | 83301-3874
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Country | US
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Telephone | 208-734-6800
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Fax | 208-735-1635
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | M-4775
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | M4775
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License Number State | ID
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