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General NPI Number Information
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NPI Number | 1700875788
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Entity Type | Individual
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Provider Name | RANDALL V OLSEN MD
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Gender | Male
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Dates
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Enumeration Date | 10/21/2005
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Last Update Date | 05/02/2017
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Provider Practice Location Address
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Address Line | 1600 E BROADWAY
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City | COLUMBIA
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State | MO
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Zip | 65201-5844
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Country | US
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Telephone | 573-815-8000
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Fax | 573-815-6343
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Provider Business Mailing Address
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Address Line | PO BOX 3242
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City | INDIANAPOLIS
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State | IN
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Zip | 46206-3242
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Country | US
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Telephone | 844-295-4873
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Fax | 844-839-0626
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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 | 2085B0100X
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Taxonomy Name | Body Imaging Physician
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License Number | 6035963-1205
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 2085D0003X
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Taxonomy Name | Diagnostic Neuroimaging (Radiology) Physician
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License Number | 6035963-1205
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License Number State | UT
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Taxonomy #3
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 6035963-1205
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License Number State | UT
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Taxonomy #4
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 11771
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License Number State | NV
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Taxonomy #5
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 2017004467
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License Number State | MO
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Taxonomy #6
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number | 2017004467
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License Number State | MO
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