JACK CANDIDO AVALOS MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****90

License Status

NOT RENEWED

Business

First Name

JACK

Middle

CANDIDO

Last Name

AVALOS

Suffix

Business Name

JACK CANDIDO AVALOS MD

Original Issue Date

02/04/2005

Effective Date

07/11/2017

Expiration Date

09/30/2020

City

URBANA

State

Zip

61801

County

KNOX

Controlled Substance Schedule

II III IV

Ever Disciplined

LastModifiedDate

01/14/2021