Provider Demographics
NPI:1679777262
Name:OLSON, MARK FREDERICK (MPH)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:FREDERICK
Last Name:OLSON
Suffix:
Gender:M
Credentials:MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19847 DOEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MONUMENT
Mailing Address - State:CO
Mailing Address - Zip Code:80132-3404
Mailing Address - Country:US
Mailing Address - Phone:719-433-0095
Mailing Address - Fax:
Practice Address - Street 1:19847 DOEWOOD DR
Practice Address - Street 2:
Practice Address - City:MONUMENT
Practice Address - State:CO
Practice Address - Zip Code:80132-3404
Practice Address - Country:US
Practice Address - Phone:719-433-0095
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program