Individual
RAY BROCK OLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
2245 N 400 E, STE 301, NORTH LOGAN, UT 84341-1892
(435) 753-7880
(435) 359-4507
Mailing address
2245 N 400 E, STE 301, NORTH LOGAN, UT 84341-1892
(435) 753-7880
(435) 359-4507
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1548303795
—
UT
Enumeration date
05/20/2019
Last updated
06/24/2022
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