Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | 00020602 | AL |
Y | 207PP0204X | Pediatric Emergency Physician | 15576 | NV |
N | 208000000X | Pediatrician | 15576 | NV |
NPI | 1285629923 |
---|---|
Provider Name | Elis Y Olson |
First Address | Birmingham, AL 35246-0314 |
Second Address | Huntsville, AL 35801-4421 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/09/2005 |
Last Update Date | 07/01/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000032416 | (05) | AL |
009939515 | (05) | AL |
051032416 | BCBS (01) | AL |
051518178 | BCBS OF ALABAMA (01) | AL |
200174262 | CHAMPUS (01) | AL |
200174262 | TRICARE (01) | AL |
2011312 | UNITED HEALTH CARE (01) | AL |
4297420 | AETNA (01) | AL |
E97661 | (02) | |
N18178 | MAILHANDLERS (01) | AL |