Provider Demographics
NPI:1831144815
Name:FRANCISCAN MEDICAL GROUP
Entity Type:Organization
Organization Name:FRANCISCAN MEDICAL GROUP
Other - Org Name:STEVEN G. DURAS, MD, FACS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF MEDICAL OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:CLIFF
Authorized Official - Middle Name:A
Authorized Official - Last Name:ROBERTSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:253-779-6101
Mailing Address - Street 1:11311 BRIDGEPORT WAY SW
Mailing Address - Street 2:#307
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-3071
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11311 BRIDGEPORT WAY SW
Practice Address - Street 2:#307
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-3071
Practice Address - Country:US
Practice Address - Phone:253-584-7029
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRANCISCAN MEDIAL GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-24
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00018963208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1796101Medicaid
WA7133218Medicaid
WA8941415OtherSTATE CRIME VICTIMS
WA8941415OtherCRIME VICTIMS
WA0208638OtherSTATE L&I
WA0222943OtherSTATE L&I
WA7133218Medicaid
WA1326440026Medicare NSC
WA8941415OtherCRIME VICTIMS
WAG8860270Medicare PIN