Basic Information
| Provider Information | |||||||||
| NPI: | 1952536997 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FRANCISCAN MEDICAL GROUP | ||||||||
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| OtherOrganizationName: | FMG-NORTHWEST NEPHROLOGY (GH) | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11511 CANTERWOOD BLVD NW | ||||||||
| Address2: | STE 300 | ||||||||
| City: | GIG HARBOR | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983325813 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2532725881 | ||||||||
| FaxNumber: | 2533830161 | ||||||||
| Practice Location | |||||||||
| Address1: | 11511 CANTERWOOD BLVD NW | ||||||||
| Address2: | STE 300 | ||||||||
| City: | GIG HARBOR | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983325813 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2532725881 | ||||||||
| FaxNumber: | 2533830161 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/20/2009 | ||||||||
| LastUpdateDate: | 05/20/2009 | ||||||||
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| AuthorizedOfficialLastName: | FIELD | ||||||||
| AuthorizedOfficialFirstName: | DEAN | ||||||||
| AuthorizedOfficialMiddleName: | A. | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF MEDICAL OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 2536804009 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | FRANCISCAN MEDICAL GROUP | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RN0300X | WA | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
No ID Information.