Provider Demographics
NPI:1487703922
Name:OLSON, JON B (MD)
Entity type:Individual
Prefix:
First Name:JON
Middle Name:B
Last Name:OLSON
Suffix:
Gender:M
Credentials:MD
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 77814
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98177-0814
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:21701 76TH AVE W
Practice Address - Street 2:#203
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-7536
Practice Address - Country:US
Practice Address - Phone:425-774-5163
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00014086208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA43512OtherL&I
OL0950OtherREGENCE
OL0950OtherREGENCE
WAGAB26970Medicare PIN