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General NPI Number Information
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NPI Number | 1558478818
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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 | 08/24/2006
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Last Update Date | 03/23/2009
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Provider Practice Location Address
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Address Line | 451 SW SEDGWICK RD STE 110
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City | PORT ORCHARD
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State | WA
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Zip | 98367
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Country | US
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Telephone | 360-874-5900
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Fax | 360-874-5959
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Provider Business Mailing Address
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Address Line | 451 SW SEDGWICK RD STE 110
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City | PORT ORCHARD
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State | WA
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Zip | 98367
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Country | US
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Telephone | 360-874-5900
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Fax | 360-874-5959
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Authorized Official
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Title or Position | CMO
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Name | DEAN FIELD
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Credential | MD
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Telephone | 253-858-9192
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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 | OP00001963
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License Number State | WA
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