Provider Demographics
NPI:1427244037
Name:OLSON, MICHAEL RAY (MD, PHD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:RAY
Last Name:OLSON
Suffix:
Gender:
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 746654
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-6654
Mailing Address - Country:US
Mailing Address - Phone:904-202-2092
Mailing Address - Fax:904-376-4075
Practice Address - Street 1:1301 PALM AVE STE 101
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-8432
Practice Address - Country:US
Practice Address - Phone:904-202-7300
Practice Address - Fax:904-202-2754
Is Sole Proprietor?:No
Enumeration Date:2007-09-18
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1042312085H0002X, 2085R0001X
CAA932452085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
No2085H0002XAllopathic & Osteopathic PhysiciansRadiologyHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP01330980OtherRR MEDICARE
FL001151700Medicaid
FLBW056GMedicare PIN
FLBW056IMedicare PIN
FLBW056HMedicare PIN
FLBW056LMedicare PIN
FLBW056RMedicare PIN
FLBW056YMedicare PIN
FLBW056KMedicare PIN
FLBW056FMedicare PIN
FLBW056HMedicare PIN
FLBW056WMedicare PIN
FLBW056IMedicare PIN