MEDICARE: DR. TAIT DELL OLAVESON D.O.

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	2086S0102X	Surgical Critical Care Physician	O-0726	ID
2	208600000X	Surgery Physician	O-0726	ID
3	2083P0011X	Undersea and Hyperbaric Medicine (Preventive Medicine) Physician	O-0726	ID

General Provider Information

NPI Number	:	1356518831
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TAIT DELL OLAVESON D.O.

Provider Business Mailing Address
First Line	:	3200 CHANNING WAY STE A206
Second Line	:
City	:	IDAHO FALLS
State	:	ID
Zip	:	83404-7586
Country	:	US
Telephone Number	:	208-529-2230
Fax Number	:

Provider Business Practice Location Address
First Line	:	3200 CHANNING WAY STE 206
Second Line	:
City	:	IDAHO FALLS
State	:	ID
Zip	:	83404-7546
Country	:	US
Telephone Number	:	208-529-2230
Fax Number	:	208-453-6142

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

Provider Enumeration Date	:	05/13/2008
Last Update Date	:	06/09/2026

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