MEDICARE: DARREL W OLSEN M.D.

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	1834321205	UT

General Provider Information

NPI Number	:	1649218462
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DARREL W OLSEN M.D.

Provider Business Mailing Address
First Line	:	PO BOX 27128
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84127-0128
Country	:	US
Telephone Number	:	435-283-4076
Fax Number	:	435-283-4078

Provider Business Practice Location Address
First Line	:	525 N MAIN ST
Second Line	:
City	:	EPHRAIM
State	:	UT
Zip	:	84627-1155
Country	:	US
Telephone Number	:	435-283-4076
Fax Number	:	435-283-4078

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

Provider Enumeration Date	:	06/03/2006
Last Update Date	:	06/15/2010

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