Organization
FRANCISCAN MEDICAL GROUP
Active
Parent organization
FRANCISCAN MEDICAL GROUP
Other names
FMG-Neurosurgery NW - Puyallup
Organization subpart
Yes
Provider details
NPI number
Legal business name
FRANCISCAN MEDICAL GROUP
Authorized official
CLIFF ROBERTSON (CHIEF MEDICAL OFFICER)
(253) 779-6101
Entity
Organization
Contact information
Practice address
205 15TH AVE SW, STE D, PUYALLUP, WA 98371-7873
(253) 426-4420
(253) 426-4383
Mailing address
1708 YAKIMA AVE, STE 105, TACOMA, WA 98405-5307
(253) 426-4420
(253) 426-4383
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0190124
STATE L&I
WA
05
—
7115728
—
WA
Enumeration date
05/24/2006
Last updated
02/20/2008
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