Basic Information
Provider Information
NPI: 1003014044
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: OLSEN
FirstName: ALEX
MiddleName: BRYAN
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 350 W THOMAS RD
Address2: DEPT. OF GENERAL SURGERY
City: PHOENIX
State: AZ
PostalCode: 850134409
CountryCode: US
TelephoneNumber: 6024066540
FaxNumber:  
Practice Location
Address1: 350 W THOMAS RD
Address2: DEPT. OF GENERAL SURGERY
City: PHOENIX
State: AZ
PostalCode: 850134409
CountryCode: US
TelephoneNumber: 6024066540
FaxNumber:  
Other Information
ProviderEnumerationDate: 07/10/2007
LastUpdateDate: 06/05/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208600000XR70161AZY Allopathic & Osteopathic PhysiciansSurgery 

No ID Information.


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