MEDICARE: MR. RON ANTHON OLSEN DPM

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	213E00000X	Podiatrist	AZ0372	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1467564897	OTHER		GROUP NPI
2	1972510675	OTHER	AZ	PROVIDER BILLING ONLY
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1972510675
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RON ANTHON OLSEN DPM

Provider Business Mailing Address
First Line	:	PO BOX 2240
Second Line	:
City	:	QUEEN CREEK
State	:	AZ
Zip	:	85142-1846
Country	:	US
Telephone Number	:	520-510-3200
Fax Number	:	480-655-5523

Provider Business Practice Location Address
First Line	:	20185 E OCOTILLO RD STE 105
Second Line	:
City	:	QUEEN CREEK
State	:	AZ
Zip	:	85142-7663
Country	:	US
Telephone Number	:	480-677-3600
Fax Number	:	480-677-3645

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

Provider Enumeration Date	:	08/02/2006
Last Update Date	:	03/01/2019

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