Healthcare Provider Details

I. General information

NPI: 1588998546
Provider Name (Legal Business Name): FRANCISCAN MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2009
Last Update Date: 09/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1628 S MILDRED ST #104
TACOMA WA
98465-1627
US

IV. Provider business mailing address

1628 S MILDRED ST #104
TACOMA WA
98465-1627
US

V. Phone/Fax

Practice location:
  • Phone: 253-565-6777
  • Fax: 253-565-8777
Mailing address:
  • Phone: 253-565-6777
  • Fax: 253-565-8777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number StateWA

VIII. Authorized Official

Name: DEAN A. FIELD
Title or Position: CHIEF MEDICAL OFFICER
Credential: MD
Phone: 253-680-4009