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General NPI Number Information
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NPI Number | 1750336129
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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 | 05/24/2006
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Last Update Date | 10/31/2008
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Provider Practice Location Address
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Address Line | 11307 BRIDGEPORT WAY SW STE 220
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City | LAKEWOOD
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State | WA
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Zip | 98499-3004
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Country | US
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Telephone | 253-512-2744
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Fax |
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Provider Business Mailing Address
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Address Line | 11307 BRIDGEPORT WAY SW STE 220
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City | LAKEWOOD
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State | WA
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Zip | 98499-3004
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CHIEF MEDICAL OFFICER
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Name | DR. 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 | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number | MD00046473
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License Number State | WA
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