FREDERICK DWAYNE JOHNSON MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036132640

License Status

NOT RENEWED

Business

First Name

FREDERICK

Middle

DWAYNE

Last Name

JOHNSON

Suffix

Business Name

FREDERICK DWAYNE JOHNSON MD

Original Issue Date

04/25/2013

Effective Date

04/25/2013

Expiration Date

07/31/2014

City

PEORIA

State

Zip

61615

County

PEORIA

Ever Disciplined

LastModifiedDate

11/17/2014