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General NPI Number Information
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NPI Number | 1912151283
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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 | 11/12/2008
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Last Update Date | 06/14/2010
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Provider Practice Location Address
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Address Line | 16850 SE 272ND ST STE 200
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City | COVINGTON
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State | WA
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Zip | 98042-4931
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Country | US
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Telephone | 253-779-6215
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Fax |
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Provider Business Mailing Address
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Address Line | 16850 SE 272ND ST STE 200
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City | COVINGTON
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State | WA
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Zip | 98042-4931
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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 | PRESIDENT
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Name | CLIFF ROBERTSON
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Credential | MD
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Telephone | 253-680-4015
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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