Provider Demographics
NPI:1942339106
Name:PETERSON, ELIZABETH SORRELLS (MD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:SORRELLS
Last Name:PETERSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14012 WINDSOR ST
Mailing Address - Street 2:
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66224-9779
Mailing Address - Country:US
Mailing Address - Phone:913-685-8233
Mailing Address - Fax:
Practice Address - Street 1:7311 W 132ND ST
Practice Address - Street 2:SUITE 190
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66213-1118
Practice Address - Country:US
Practice Address - Phone:913-217-3279
Practice Address - Fax:502-508-4660
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO111793208000000X
KS04-26672208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics