Provider Demographics
NPI:1366563389
Name:OLSEN, GREGG H (MD)
Entity type:Individual
Prefix:
First Name:GREGG
Middle Name:H
Last Name:OLSEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1919 14TH ST
Mailing Address - Street 2:SUITE 711
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80302-5310
Mailing Address - Country:US
Mailing Address - Phone:303-443-7600
Mailing Address - Fax:303-402-0292
Practice Address - Street 1:1919 14TH ST
Practice Address - Street 2:SUITE 711
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80302-5310
Practice Address - Country:US
Practice Address - Phone:303-443-7600
Practice Address - Fax:303-402-0292
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO334832084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry