Basic Information
| Provider Information | |||||||||
| NPI: | 1770863466 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FRANCISCAN MEDICAL GROUP | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | FRANCISCAN DIGESTIVE CARE ASSOCIATES-LAKEWOOD | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11311 BRIDGEPORT WAY SW | ||||||||
| Address2: | STE 207 | ||||||||
| City: | LAKEWOOD | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984993071 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2532728664 | ||||||||
| FaxNumber: | 2536277880 | ||||||||
| Practice Location | |||||||||
| Address1: | 11311 BRIDGEPORT WAY SW | ||||||||
| Address2: | STE 207 | ||||||||
| City: | LAKEWOOD | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984993071 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2532728664 | ||||||||
| FaxNumber: | 2536277880 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/25/2011 | ||||||||
| LastUpdateDate: | 08/25/2011 | ||||||||
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| AuthorizedOfficialLastName: | SPARE | ||||||||
| AuthorizedOfficialFirstName: | STEPHEN | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT & CHIEF MEDICAL OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 2536804009 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.