Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 9689 | FL |
Y | 213EG0000X | General Practice | 9689 | FL |
N | 1223P0700X | Prosthodontist | 9689 | FL |
NPI | 1083678262 |
---|---|
Provider Name | Dr. Eric M Olson |
First Address | Jacksonville, FL 32211-4119 |
Second Address | Fernandina Beach, FL 32034-4462 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2006 |
Last Update Date | 05/01/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
629935 | UNITED CONCORDIA PROVIDER (01) | FL |
67256 | BCBS PROVIDER (01) | FL |