Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204E00000X | Oral & Maxillofacial Surgeon | MD00042819 | WA |
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | MD00042819 | WA |
NPI | 1073550265 |
---|---|
Provider Name | David Erik Olson |
First Address | Bellingham, WA 98225-1892 |
Second Address | Bellingham, WA 98225-1892 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2006 |
Last Update Date | 05/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8373714 | (05) | WA |
H95013 | (02) |