Organization
GORDON S OLSEN DO PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GORDON S OLSEN D.O. (ORTHOPEDIC SURGEON)
(307) 789-0096
Entity
Organization
Contact information
Practice address
170 ARROWHEAD DRIVE, SUITE 3, EVANSTON, WY 82930-9266
(307) 789-0096
(307) 789-0860
Mailing address
PO BOX 796, HEBER CITY, UT 84032-0796
(307) 789-0096
(307) 789-0860
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
—
WY
335E00000X
Prosthetic/Orthotic Supplier
—
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00593001
BCBS
WY
05
—
122536700
—
WY
Enumeration date
03/14/2007
Last updated
03/03/2008
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