Basic Information
| Provider Information | |||||||||
| NPI: | 1689617482 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | OLSGARD | ||||||||
| FirstName: | EDWARD | ||||||||
| MiddleName: | CHARLES | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 2675 HARRIS ST | ||||||||
| Address2: | |||||||||
| City: | EUREKA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 955034806 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7074438335 | ||||||||
| FaxNumber: | 7074437327 | ||||||||
| Practice Location | |||||||||
| Address1: | 2675 HARRIS ST | ||||||||
| Address2: | |||||||||
| City: | EUREKA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 955034806 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7074438335 | ||||||||
| FaxNumber: | 7074437327 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/13/2006 | ||||||||
| LastUpdateDate: | 11/25/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | G25166 | CA | Y | Other Service Providers | Specialist |
No ID Information.