Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | R70161 | AZ |
N | 208600000X | Surgeon | R70161 | AZ |
Y | 2086S0102X | Surgical Critical Care | 35592 | OK |
NPI | 1003014044 |
---|---|
Provider Name | Alex Bryan Olsen |
First Address | Tulsa, OK 74136-3331 |
Second Address | Tulsa, OK 74136-1902 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2007 |
Last Update Date | 05/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200910850A | (05) | OK |