MEDICARE: ELIZABETH K PETERSON MD

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	208000000X	Pediatrics Physician	G68921	CA

General Provider Information

NPI Number	:	1700868361
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH K PETERSON MD

Provider Business Mailing Address
First Line	:	PO BOX 45680
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94145-0680
Country	:	US
Telephone Number	:	530-626-1144
Fax Number	:	530-626-7146

Provider Business Practice Location Address
First Line	:	4341 GOLDEN CENTER DR
Second Line	:	SUITE A
City	:	PLACERVILLE
State	:	CA
Zip	:	95667-6260
Country	:	US
Telephone Number	:	530-626-1144
Fax Number	:	530-626-7146

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/18/2005
Last Update Date	:	08/25/2009

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