Organization
FRANCISCAN MEDICAL GROUP
Active
Parent organization
FRANCISCAN MEDICAL GROUP
Other names
Lakes Family Medicine-Bonnie Lake
Organization subpart
Yes
Provider details
NPI number
Legal business name
FRANCISCAN MEDICAL GROUP
Authorized official
CLIFF A. ROBERTSON MD (PRESIDENT/ CHIEF MEDICAL OFFICER)
(253) 779-6101
Entity
Organization
Contact information
Practice address
8412 MYERS RD E, STE 203, BONNEY LAKE, WA 98391-5112
(253) 863-2587
(253) 863-2588
Mailing address
8412 MYERS RD E, STE 203, BONNEY LAKE, WA 98391-5112
(253) 863-2587
(253) 863-2588
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0224335
STATE L&I
WA
05
—
7139181
—
WA
Enumeration date
08/27/2007
Last updated
02/20/2008
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