Provider Demographics
NPI:1376691311
Name:OLSON, ROBERT M (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:M
Last Name:OLSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:3138 NORTHSIDE DR
Mailing Address - Street 2:
Mailing Address - City:KEY WEST
Mailing Address - State:FL
Mailing Address - Zip Code:33040-8028
Mailing Address - Country:US
Mailing Address - Phone:305-295-3838
Mailing Address - Fax:305-295-7772
Practice Address - Street 1:3138 NORTHSIDE DR
Practice Address - Street 2:
Practice Address - City:KEY WEST
Practice Address - State:FL
Practice Address - Zip Code:33040-8028
Practice Address - Country:US
Practice Address - Phone:305-295-3838
Practice Address - Fax:305-295-7772
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME0066579207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL376475300Medicaid
FLD80255Medicare UPIN
FL25583WMedicare ID - Type Unspecified