Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 30332 | CO |
NPI | 1023050184 |
---|---|
Provider Name | Daniel Olson |
First Address | Delta, CO 81416-1129 |
Second Address | Delta, CO 81416-2407 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01303320 | (05) | CO |
680565304001 | RMHP PROVIDER NUMBER (01) | CO |
E60771 | (02) | CO |
OL038533 | BCBS IND PROV NUMBER (01) | CO |