Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | 350460580 | OH |
NPI | 1023005261 |
---|---|
Provider Name | Thomas George Olsen |
First Address | Dayton, OH 45459-4021 |
Second Address | Dayton, OH 45459-4021 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2005 |
Last Update Date | 30/01/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A80808 | (02) |