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General NPI Number Information
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NPI Number | 1356486260
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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 | 02/20/2007
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Last Update Date | 06/20/2008
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Provider Practice Location Address
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Address Line | 1175 CENTER DR #130
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City | DUPONT
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State | WA
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Zip | 98327-7733
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Country | US
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Telephone | 253-539-9735
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Fax | 253-539-7981
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Provider Business Mailing Address
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Address Line | 1175 CENTER DR #130
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City | DUPONT
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State | WA
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Zip | 98327-7733
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Country | US
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Telephone | 253-964-5260
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Fax | 253-964-5266
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Authorized Official
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Title or Position | CHIEF MEDICAL OFFICER
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Name | CLIFF A. 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 | OP00002173
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License Number State | WA
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