Individual
JON B OLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
21701 76TH AVE W, #203, EDMONDS, WA 98026-7536
(425) 774-5163
Mailing address
PO BOX 77814, SEATTLE, WA 98177-0814
Taxonomy
Speciality
Code
Description
License number
State
208VP0000X
Pain Medicine Physician
Primary
00014086
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
43512
L&I
WA
01
—
OL0950
REGENCE
—
Enumeration date
01/10/2007
Last updated
10/26/2007
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