Basic Information
| Provider Information | |||||||||
| NPI: | 1649370750 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OLSON | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 660 S EUCLID AVE | ||||||||
| Address2: | MSC 8109-0037-09 | ||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631101010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3143622280 | ||||||||
| FaxNumber: | 8883528360 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 BARNES JEWISH HOSPITAL PLZ | ||||||||
| Address2: | DIV SURG ONCOLOGY | ||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631101003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3143622280 | ||||||||
| FaxNumber: | 8883528360 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/25/2006 | ||||||||
| LastUpdateDate: | 09/23/2022 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | 07/17/2007 | ||||||||
| NPIReactivationDate: | 10/24/2007 | ||||||||
| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 2022028862 | MO | N | Allopathic & Osteopathic Physicians | Surgery | 2086X0206X | 2022028862 | MO | Y | Allopathic & Osteopathic Physicians | Surgery | Surgical Oncology |
No ID Information.