Healthcare Provider Details

I. General information

NPI: 1760768402
Provider Name (Legal Business Name): FRANCISCAN MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2011
Last Update Date: 10/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1802 YAKIMA AVE STE 204
TACOMA WA
98405-4499
US

IV. Provider business mailing address

1802 YAKIMA AVE STE 204
TACOMA WA
98405-4499
US

V. Phone/Fax

Practice location:
  • Phone: 253-383-3325
  • Fax: 253-572-7875
Mailing address:
  • Phone: 253-383-3325
  • Fax: 253-572-7875

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: STEPHEN SPARE
Title or Position: PRESIDENT AND CMO
Credential: MD
Phone: 253-680-4009