# DR. CORNELIUS R PETERSON

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1063642957
- **Gender:** Man
- **Credential:** MD

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207L00000X | Anesthesiology Physician | 27117 | NE | — |
| 207L00000X | Anesthesiology Physician | 9407283 | KS | — |
| 207L00000X | Anesthesiology Physician | MD61305762 | WA | Yes |
| 207R00000X | Internal Medicine Physician | 9407283 | KS | — |

## Other

- **Enumeration date:** 07/25/2009
- **Last updated:** 08/01/2022