Individual
DR. TAIT DELL OLAVESON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
3200 CHANNING WAY STE 206, IDAHO FALLS, ID 83404-7546
(208) 529-2230
(208) 453-6142
Mailing address
PO BOX 277381, ATLANTA, GA 30384-7381
Taxonomy
Speciality
Code
Description
License number
State
2083P0011X
Undersea and Hyperbaric Medicine (Preventive Medicine) Physician
O-0726
ID
208600000X
Surgery Physician
13411C
WY
208600000X
Surgery Physician
179881
AK
208600000X
Surgery Physician
82499
GA
208600000X
Surgery Physician
93936
MT
208600000X
Surgery Physician
Primary
O-0726
ID
Other
Enumeration date
05/13/2008
Last updated
06/04/2024
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