Individual
DR. JOHN P OLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
802 N RIVERSIDE RD, SUITE 150, SAINT JOSEPH, MO 64507-9794
(816) 271-4025
(816) 271-4026
Mailing address
802 N RIVERSIDE RD, SUITE 150, SAINT JOSEPH, MO 64507-9794
(816) 271-4025
(816) 271-4026
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
102486
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100177320B
—
KS
01
—
140006377
RR MEDICARE
MO
05
—
207918228
—
MO
Enumeration date
07/07/2006
Last updated
11/27/2017
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