Healthcare Provider Details

I. General information

NPI: 1235132705
Provider Name (Legal Business Name): STEVE R FELLER DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2005
Last Update Date: 11/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7507 CUSTER RD W
TACOMA WA
98499-8138
US

IV. Provider business mailing address

7507 CUSTER RD W
TACOMA WA
98499-8138
US

V. Phone/Fax

Practice location:
  • Phone: 253-472-6530
  • Fax: 253-472-6693
Mailing address:
  • Phone: 253-472-6530
  • Fax: 253-472-6693

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPO0000317
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPOD0000317
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: