Healthcare Provider Details

I. General information

NPI: 1629016936
Provider Name (Legal Business Name): FRANCISCAN MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 06/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1708 YAKIMA AVE STE 202
TACOMA WA
98405-5307
US

IV. Provider business mailing address

1708 YAKIMA AVE STE 202
TACOMA WA
98405-5307
US

V. Phone/Fax

Practice location:
  • Phone: 253-426-6878
  • Fax: 253-426-4254
Mailing address:
  • Phone: 253-426-6878
  • Fax: 253-426-4254

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License NumberMD00023541
License Number StateWA

VIII. Authorized Official

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