PHILLIP WAYNE JANSEN DO Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036105566

License Status

NOT RENEWED

Business

First Name

PHILLIP

Middle

WAYNE

Last Name

JANSEN

Suffix

Business Name

PHILLIP WAYNE JANSEN DO

Original Issue Date

09/12/2001

Effective Date

06/03/2011

Expiration Date

07/31/2014

City

WASHINGTON

State

Zip

61571

County

TAZEWELL

Ever Disciplined

LastModifiedDate

11/17/2014