MEDICARE: PACIFIC PODIATRY GROUP, PS

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	213E00000X	Podiatrist	600637306	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	64061	OTHER	WA	LABOR & INDUSTRIES
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235165549
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PACIFIC PODIATRY GROUP, PS

Provider Business Mailing Address
First Line	:	7808 PACIFIC AVE
Second Line	:	SUITE 1
City	:	TACOMA
State	:	WA
Zip	:	98408-7039
Country	:	US
Telephone Number	:	253-473-5566
Fax Number	:	253-882-0988

Provider Business Practice Location Address
First Line	:	7808 PACIFIC AVE
Second Line	:	SUITE 1
City	:	TACOMA
State	:	WA
Zip	:	98408-7039
Country	:	US
Telephone Number	:	253-473-5566
Fax Number	:	253-473-6436

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. STEPHEN M FUSON
Credential	:	DPM
Telephone Number	:	253-473-5566

Provider Enumeration Date	:	06/26/2006
Last Update Date	:	06/09/2026

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