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General NPI Number Information
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NPI Number | 1922297324
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Entity Type | Organization
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Legal Business Name | GORDON S OLSEN, DO PC
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Dates
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Enumeration Date | 10/22/2007
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Last Update Date | 05/07/2008
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Provider Practice Location Address
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Address Line | 1485 S HIGHWAY 40
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City | HEBER CITY
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State | UT
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Zip | 84032-3522
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Country | US
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Telephone | 435-654-6360
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Fax | 435-657-0294
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Provider Business Mailing Address
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Address Line | PO BOX 796
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City | HEBER CITY
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State | UT
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Zip | 84032-0796
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Country | US
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Telephone | 435-654-6360
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Fax | 435-654-0805
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Authorized Official
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Title or Position | ORTHOPEDIC SURGEON
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Name | GORDON S. OLSEN
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Credential | D.O.
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Telephone | 435-654-6360
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State | UT
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