Provider Demographics
NPI:1700868361
Name:PETERSON, ELIZABETH K (MD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:K
Last Name:PETERSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 45680
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94145-0680
Mailing Address - Country:US
Mailing Address - Phone:530-626-1144
Mailing Address - Fax:530-626-7146
Practice Address - Street 1:4341 GOLDEN CENTER DR
Practice Address - Street 2:SUITE A
Practice Address - City:PLACERVILLE
Practice Address - State:CA
Practice Address - Zip Code:95667-6260
Practice Address - Country:US
Practice Address - Phone:530-626-1144
Practice Address - Fax:530-626-7146
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2009-08-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG68921208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics