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General NPI Number Information
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NPI Number | 1770592016
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Entity Type | Individual
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Provider Name | STACEY L PERRY DPM
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Gender | Female
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Dates
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Enumeration Date | 08/05/2006
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Last Update Date | 10/05/2015
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Provider Practice Location Address
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Address Line | 34509 9TH AVE S STE 306
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City | FEDERAL WAY
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State | WA
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Zip | 98003-6700
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Country | US
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Telephone | 253-242-5293
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Fax | 523-944-4004
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Provider Business Mailing Address
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Address Line | 34509 9TH AVE S STE 306
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City | FEDERAL WAY
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State | WA
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Zip | 98003-6700
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Country | US
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Telephone | 253-242-5293
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Fax | 523-944-4004
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | PO00000740
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License Number State | WA
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