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General NPI Number Information
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NPI Number | 1366463226
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Entity Type | Organization
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Legal Business Name | JAY E. OLSSON, D.O., P.A.
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Dates
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Enumeration Date | 07/23/2006
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Last Update Date | 04/09/2015
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Provider Practice Location Address
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Address Line | 401 N WICKHAM RD SUITE S
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City | MELBOURNE
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State | FL
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Zip | 32935-8659
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Country | US
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Telephone | 321-242-9031
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Fax | 321-242-9035
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Provider Business Mailing Address
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Address Line | 401 N WICKHAM RD SUITE S
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City | MELBOURNE
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State | FL
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Zip | 32935-8659
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Country | US
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Telephone | 321-242-9031
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Fax | 321-242-9035
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | JAY EDWARD OLSSON
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Credential | D.O.
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Telephone | 321-242-9031
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | OS0004087
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License Number State | FL
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