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General NPI Number Information
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NPI Number | 1265643803
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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 | 05/25/2007
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Last Update Date | 07/02/2012
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Provider Practice Location Address
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Address Line | 4700 POINT FOSDICK DR NW STE 202
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City | GIG HARBOR
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State | WA
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Zip | 98335-1706
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Country | US
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Telephone | 253-857-1450
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Fax | 253-857-1489
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Provider Business Mailing Address
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Address Line | 4700 POINT FOSDICK DR NW STE 202
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City | GIG HARBOR
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State | WA
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Zip | 98335-1706
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Country | US
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Telephone | 253-857-1450
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Fax | 253-857-1489
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Authorized Official
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Title or Position | CMO
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Name | CLIFF ROBERTSON
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Credential | MD
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | OP00001673
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License Number State | WA
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