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Individual

DR. STACY L PETERSON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
818 N EMPORIA ST, SUITE 305, WICHITA, KS 67214-3729
(316) 265-1441
(316) 265-1685
Mailing address
818 N EMPORIA ST, SUITE 305, WICHITA, KS 67214-3729
(316) 265-1441
(316) 265-1685

Taxonomy

Speciality
Code
Description
License number
State
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
0419242
KS

Other

Enumeration date
09/30/2006
Last updated
07/08/2007
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