Organization
GORDON S OLSEN, DO PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GORDON S. OLSEN D.O. (ORTHOPEDIC SURGEON)
(435) 654-6360
Entity
Organization
Contact information
Practice address
1485 S HIGHWAY 40, HEBER CITY, UT 84032-3522
(435) 654-6360
(435) 657-0294
Mailing address
PO BOX 796, HEBER CITY, UT 84032-0796
(435) 654-6360
(435) 654-0805
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
—
UT
335E00000X
Prosthetic/Orthotic Supplier
—
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
520192386001
—
UT
01
—
932689281050
BLUE CROSS
UT
Enumeration date
10/22/2007
Last updated
05/07/2008
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