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General NPI Number Information
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NPI Number | 1164437851
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Entity Type | Organization
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Legal Business Name | FRANCISCAN MEDICAL GROUP
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Dates
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Enumeration Date | 07/30/2006
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Last Update Date | 02/11/2009
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Provider Practice Location Address
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Address Line | 200 AUBURN AVE
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City | AUBURN
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State | WA
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Zip | 98002-5015
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Country | US
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Telephone | 253-833-1986
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Fax | 253-939-0521
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Provider Business Mailing Address
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Address Line | 200 AUBURN AVE
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City | AUBURN
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State | WA
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Zip | 98002-5015
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Country | US
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Telephone | 253-833-1986
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Fax | 253-939-0521
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Authorized Official
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Title or Position | CHIEF MEDICAL OFFICER
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Name | CLIFF ROBERTSON
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Credential |
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Telephone | 253-779-6101
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | PO00000816
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | MD00029862
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License Number State | WA
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