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General NPI Number Information
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NPI Number | 1922413657
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Entity Type | Organization
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Legal Business Name | MARK H OLSEN DPM PLLC
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Dates
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Enumeration Date | 06/20/2014
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Last Update Date | 06/20/2014
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Provider Practice Location Address
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Address Line | 220 N STAPLEY DR #1
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City | MESA
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State | AZ
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Zip | 85203-8057
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Country | US
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Telephone | 623-234-8131
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Fax | 623-234-8147
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Provider Business Mailing Address
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Address Line | 220 N STAPLEY DR #1
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City | MESA
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State | AZ
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Zip | 85203-8057
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Country | US
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Telephone | 623-234-8131
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Fax | 623-234-8147
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. DEBBIE J SOTA
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Credential |
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Telephone | 623-234-8131
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 0762
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License Number State | AZ
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