Healthcare Provider Details

I. General information

NPI: 1386679207
Provider Name (Legal Business Name): FRANCISCAN MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 02/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1708 YAKIMA AVE STE 110
TACOMA WA
98405-5307
US

IV. Provider business mailing address

1708 YAKIMA AVE STE 110
TACOMA WA
98405-5307
US

V. Phone/Fax

Practice location:
  • Phone: 253-627-9151
  • Fax:
Mailing address:
  • Phone: 253-627-9151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD00035180
License Number StateWA

VIII. Authorized Official

Name: CLIFF A ROBERTSON
Title or Position: CHIEF MEDICAL OFFICER
Credential: MD
Phone: 253-779-6101