TODD CHARLES PETERSON DO Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036135069

License Status

NOT RENEWED

Business

Title

First Name

TODD

Middle

CHARLES

Last Name

PETERSON

Business Name

TODD CHARLES PETERSON DO

Original Issue Date

04/22/2014

Effective Date

04/22/2014

Expiration Date

07/31/2017

City

SPRINGFIELD

State

Zip

62702

County

SANGAMON

Ever Disciplined

LastModifiedDate

11/01/2017