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NPI Code Detail

MEDICARE: SPENCER SHIRL OLSEN MD

MEDICARE: SPENCER SHIRL OLSEN 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
12083X0100XOccupational Medicine PhysicianA88450CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1A88450OTHERCALICENSE
2MD00045600OTHERWALICENSE

General Provider Information

NPI Number : 1962412767
Entity Type Code : Individual
Provider Name (Legal Business Name) : SPENCER SHIRL OLSEN MD
Provider Business Mailing Address
First Line : 1800 E SHELBY ST
Second Line :
City : SEATTLE
State : WA
Zip : 98112
Country : US
Telephone Number : 206-852-8661
Fax Number :
Provider Business Practice Location Address
First Line : 5575 RUFFIN ROAD
Second Line : US HEALTH WORKS SUITE 100
City : SAN DIEGO
State : CA
Zip : 92123-1361
Country : US
Telephone Number : 858-565-1300
Fax Number : 858-565-6932
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/08/2006
Last Update Date : 07/08/2007

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