MEDICARE: FRANCISCAN MEDICAL GROUP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208800000X	Urology Physician		WA

General Provider Information

NPI Number	:	1396063525
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FRANCISCAN MEDICAL GROUP

Provider Business Mailing Address
First Line	:	451 SW SEDGWICK RD
Second Line	:	STE 220
City	:	PORT ORCHARD
State	:	WA
Zip	:	98367-6425
Country	:	US
Telephone Number	:	360-874-7300
Fax Number	:	360-874-7319

Provider Business Practice Location Address
First Line	:	451 SW SEDGWICK RD
Second Line	:	STE 220
City	:	PORT ORCHARD
State	:	WA
Zip	:	98367-6425
Country	:	US
Telephone Number	:	360-874-7300
Fax Number	:	360-874-7319

Authorized Official
Title or Position	:	PRESIDENT AND CHIEF MEDICAL OFFICER
Name	:	DEAN A. FIELD
Credential	:	MD
Telephone Number	:	253-779-4009

Provider Enumeration Date	:	05/12/2010
Last Update Date	:	05/12/2010

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