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NPI Code Detail

MEDICARE: MR. GORDON S OLSEN DOPC

MEDICARE: MR. GORDON S OLSEN DOPC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207X00000XOrthopaedic Surgery Physician2689281204UT

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1235237744
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. GORDON S OLSEN DOPC
Provider Business Mailing Address
First Line : PO BOX 30180
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84130-0180
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 454 E MEDICAL WAY
Second Line :
City : HEBER CITY
State : UT
Zip : 84032-1391
Country : US
Telephone Number : 435-722-4691
Fax Number : 435-722-9291
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/20/2006
Last Update Date : 05/12/2025

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