MEDICARE: JAY L. OLSON 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	207L00000X	Anesthesiology Physician	15318	OK

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	:	1669456612
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAY L. OLSON M.D.

Provider Business Mailing Address
First Line	:	1111 N LEE AVE
Second Line	:	SUITE 236
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73103-2600
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1000 N LINCOLN BLVD
Second Line	:	SUITE 150
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73104-3252
Country	:	US
Telephone Number	:	405-272-9644
Fax Number	:

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

Provider Enumeration Date	:	12/02/2005
Last Update Date	:	07/08/2007

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