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NPI Code Detail

MEDICARE: BRYCE DAVID OLSEN D.O.

MEDICARE: BRYCE DAVID OLSEN 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
1208000000XPediatrics PhysicianR2501AZ

General Provider Information

NPI Number : 1487034682
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRYCE DAVID OLSEN D.O.
Provider Business Mailing Address
First Line : 4531 E HAMPTON AVE
Second Line :
City : MESA
State : AZ
Zip : 85206-3366
Country : US
Telephone Number : 208-360-3485
Fax Number :
Provider Business Practice Location Address
First Line : 1501 N CAMPBELL AVE
Second Line :
City : TUCSON
State : AZ
Zip : 85724-0001
Country : US
Telephone Number : 520-626-6053
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/02/2015
Last Update Date : 06/02/2015

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