Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 35470 | AZ |
Y | 2080P0205X | Pediatric Endocrinologist | 35470 | AZ |
NPI | 1417981440 |
---|---|
Provider Name | Micah L Olson |
First Address | Phoenix, AZ 85018-2327 |
Second Address | Phoenix, AZ 85006-1464 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2006 |
Last Update Date | 26/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
122062 | (05) | AZ |