Healthcare Provider Details

I. General information

NPI: 1447208293
Provider Name (Legal Business Name): FRANCISCAN MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 06/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1708 YAKIMA AVE STE 105
TACOMA WA
98405-5307
US

IV. Provider business mailing address

1708 YAKIMA AVE STE 105
TACOMA WA
98405-5307
US

V. Phone/Fax

Practice location:
  • Phone: 253-426-4420
  • Fax: 253-426-4383
Mailing address:
  • Phone: 253-426-4420
  • Fax: 253-426-4383

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number State

VIII. Authorized Official

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