Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | MD21208 | TN |
N | 207VX0000X | Obstetrician | MD21208 | TN |
NPI | 1003801929 |
---|---|
Provider Name | Martin E. Olsen |
First Address | Mountain Home, TN 37684-0699 |
Second Address | Johnson City, TN 37604 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/09/2005 |
Last Update Date | 23/05/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E94538 | (02) |