MEDICARE: CONNIE OLSON MD

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
1	207Q00000X	Family Medicine Physician	MD206410	LA
2	207Q00000X	Family Medicine Physician	53169	AZ

Other Identifiers

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

General Provider Information

NPI Number	:	1255658126
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CONNIE OLSON MD

Provider Business Mailing Address
First Line	:	5055 E BROADWAY BLVD STE A100
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85711-3629
Country	:	US
Telephone Number	:	520-327-0460
Fax Number	:	520-795-0225

Provider Business Practice Location Address
First Line	:	8710 N THORNYDALE RD STE 160
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85742-5037
Country	:	US
Telephone Number	:	520-744-2900
Fax Number	:	520-744-3318

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/30/2010
Last Update Date	:	05/14/2024

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Directions to “ CONNIE OLSON MD” Practice Location

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