Provider Demographics
NPI:1710497185
Name:FRANCETICH, GABRIEL JOSEPH (PA-C)
Entity Type:Individual
Prefix:
First Name:GABRIEL
Middle Name:JOSEPH
Last Name:FRANCETICH
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11790 SW BARNES RD STE 140
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-5938
Mailing Address - Country:US
Mailing Address - Phone:503-643-2100
Mailing Address - Fax:503-643-7300
Practice Address - Street 1:11790 SW BARNES RD STE 140
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-5938
Practice Address - Country:US
Practice Address - Phone:503-643-2100
Practice Address - Fax:503-643-7300
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-11
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA189123363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500783974Medicaid