Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | 18693 | WI |
NPI | 1033182696 |
---|---|
Provider Name | Robert Carl Martin Olson |
First Address | Bloomington, MN 55425-1672 |
Second Address | Minneapolis, MN 55454-1321 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/02/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D81430 | (02) |