Healthcare Provider Details

I. General information

NPI: 1407805716
Provider Name (Legal Business Name): FRANCISCAN MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2006
Last Update Date: 08/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1708 YAKIMA AVE SUITE 112
TACOMA WA
98405-5307
US

IV. Provider business mailing address

1708 YAKIMA AVE SUITE 112
TACOMA WA
98405-5307
US

V. Phone/Fax

Practice location:
  • Phone: 253-627-6731
  • Fax: 253-627-1064
Mailing address:
  • Phone: 253-627-6731
  • Fax: 253-627-1064

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State

VIII. Authorized Official

Name: CLIFF ROBERTSON
Title or Position: CHIEF MEDICAL OFFICER
Credential: MD
Phone: 253-207-4854