Individual
JAY EDWARD OLSSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO PROF ASSOCIATIONN
Contact information
Practice address
401 N WICKHAM RD, SUITE S, MELBOURNE, FL 32935-8659
(321) 242-9031
(321) 242-9035
Mailing address
401 N WICKHAM RD, SUITE S, MELBOURNE, FL 32935-8659
(321) 242-9031
(321) 242-9035
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
OS0004087
FL
208VP0000X
Pain Medicine Physician
OS4087
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
045794900
—
FL
Enumeration date
06/15/2006
Last updated
09/16/2013
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