Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081P2900X | Pain Medicine | 311166-1205 | UT |
NPI | 1225036064 |
---|---|
Provider Name | Brian K Olenslager |
First Address | Salt Lake City, UT 84127-0688 |
Second Address | Provo, UT 84604-6601 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
31116612000001 | BXBS (01) | UT |
I10723 | (02) | UT |