Provider Demographics
NPI:1093945677
Name:FRANCISCAN MEDICAL GROUP
Entity Type:Organization
Organization Name:FRANCISCAN MEDICAL GROUP
Other - Org Name:FMG-FRANCISCAN PLASTIC & RECONSTRUCTIVE SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF MEDICAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:FIELD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:253-680-4009
Mailing Address - Street 1:11311 BRIDGEPT WAY SW
Mailing Address - Street 2:STE 309
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-3071
Mailing Address - Country:US
Mailing Address - Phone:253-985-6630
Mailing Address - Fax:253-985-6631
Practice Address - Street 1:11311 BRIDGEPT WAY SW
Practice Address - Street 2:STE 309
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-3071
Practice Address - Country:US
Practice Address - Phone:253-985-6630
Practice Address - Fax:253-985-6631
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRANCISCAN MEDICAL GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-07-17
Last Update Date:2009-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Multi-Specialty