Provider Demographics
NPI:1588902902
Name:OLSON PEDIATRIC CLINIC, LLC
Entity type:Organization
Organization Name:OLSON PEDIATRIC CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-635-3743
Mailing Address - Street 1:16463 BOONES FERRY RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-4259
Mailing Address - Country:US
Mailing Address - Phone:503-635-3743
Mailing Address - Fax:503-636-7404
Practice Address - Street 1:16463 BOONES FERRY RD
Practice Address - Street 2:SUITE 400
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-4259
Practice Address - Country:US
Practice Address - Phone:503-635-3743
Practice Address - Fax:503-636-7404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-18
Last Update Date:2013-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty