Individual
RANDALL V OLSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1600 E BROADWAY, COLUMBIA, MO 65201-5844
(573) 815-8000
(573) 815-6343
Mailing address
PO BOX 3242, INDIANAPOLIS, IN 46206-3242
(844) 295-4873
(844) 839-0626
Taxonomy
Speciality
Code
Description
License number
State
2085B0100X
Body Imaging Physician
6035963-1205
UT
2085D0003X
Diagnostic Neuroimaging (Radiology) Physician
6035963-1205
UT
2085R0202X
Diagnostic Radiology Physician
11771
NV
2085R0202X
Diagnostic Radiology Physician
Primary
2017004467
MO
2085R0202X
Diagnostic Radiology Physician
6035963-1205
UT
2085R0204X
Vascular & Interventional Radiology Physician
2017004467
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
107044372101
IHC
—
05
—
1093702185
—
MO
01
—
60359631200001
BX
UT
05
—
870487570004
—
UT
01
—
870487570RDS
EMIA
UT
Enumeration date
10/21/2005
Last updated
05/02/2017
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