Provider Demographics
NPI:1447516778
Name:OLAFSEN, NATHAN PARKE (MD)
Entity type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:PARKE
Last Name:OLAFSEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 60352
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63160-0352
Mailing Address - Country:US
Mailing Address - Phone:314-996-8099
Mailing Address - Fax:314-996-8132
Practice Address - Street 1:12634 OLIVE BLVD
Practice Address - Street 2:DEPT ORTHOPAEDIC SURGERY
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-6337
Practice Address - Country:US
Practice Address - Phone:314-996-8099
Practice Address - Fax:314-996-8132
Is Sole Proprietor?:No
Enumeration Date:2012-04-11
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017016490208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO200043385Medicaid