Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207ND0101X | MOHS-Micrographic Surgeon | 2012-02257 | NC |
N | 207ND0101X | MOHS-Micrographic Surgeon | MD39964 | SC |
NPI | 1174783385 |
---|---|
Provider Name | Jonathan M Olson |
First Address | Charlotte, NC 28277-4653 |
Second Address | Charlotte, NC 28277-4653 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2008 |
Last Update Date | 13/09/2016 |