MEDICARE: GEORGE PETZINGER M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	MD00038547	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	139616	OTHER	WA	L & I
3	911019392	OTHER		COMMERCIAL
4	8254252	OTHER	WA	CHPW

General Provider Information

NPI Number	:	1003905522
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GEORGE PETZINGER M.D.

Provider Business Mailing Address
First Line	:	2816 SW 300TH PL
Second Line	:
City	:	FEDERAL WAY
State	:	WA
Zip	:	98023-2325
Country	:	US
Telephone Number	:	509-307-8053
Fax Number	:

Provider Business Practice Location Address
First Line	:	3857 MARTIN WAY E
Second Line	:
City	:	OLYMPIA
State	:	WA
Zip	:	98506-5268
Country	:	US
Telephone Number	:	360-704-7170
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/12/2006
Last Update Date	:	05/26/2026

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