Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0000X | Hematologist | MD17386 | OR |
NPI | 1407859184 |
---|---|
Provider Name | Dr. Kevin Donald Olson |
First Address | Tualatin, OR 97062-7707 |
Second Address | Tualatin, OR 97062-7707 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2005 |
Last Update Date | 22/12/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
072780 | (05) | OR |
2006586 | (05) | WA |
E47563 | (02) | OR |