Basic Information
| Provider Information | |||||||||
| NPI: | 1932394186 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | OLSON | ||||||||
| FirstName: | BENJAMIN | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3290 | ||||||||
| Address2: | |||||||||
| City: | LA GRANDE | ||||||||
| State: | OR | ||||||||
| PostalCode: | 978507290 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5419631967 | ||||||||
| FaxNumber: | 5419631837 | ||||||||
| Practice Location | |||||||||
| Address1: | 710 SUNSET DR STE F | ||||||||
| Address2: | |||||||||
| City: | LA GRANDE | ||||||||
| State: | OR | ||||||||
| PostalCode: | 97850 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5416633100 | ||||||||
| FaxNumber: | 5419755135 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/11/2007 | ||||||||
| LastUpdateDate: | 07/24/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | DO162272 | OR | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | 58002398 | OH | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.