Individual
DR. PATRICIA M OLM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1050 N SAN FRANCISCO ST, STE B, FLAGSTAFF, AZ 86001-3259
(928) 214-3737
(928) 214-3837
Mailing address
1200 N BEAVER ST, PAYER CREDENTIALING, FLAGSTAFF, AZ 86001-3118
(928) 213-6235
(928) 213-6292
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
22349
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
738093
HUMANA
—
05
—
809202
—
AZ
01
—
AZ0379910
BLUE CROSS BLUE SHIELD
AZ
Enumeration date
09/22/2005
Last updated
01/06/2017
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