JORGE LUIS GRANADILLO DE LUQUE MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****00

License Status

ACTIVE

Business

Title

First Name

JORGE LUIS

Last Name

GRANADILLO DE LUQUE

Business Name

JORGE LUIS GRANADILLO DE LUQUE MD

Original Issue Date

06/01/2023

Effective Date

06/01/2023

Expiration Date

07/31/2026

City

SHILOH

State

Zip

62269

County

SAINT CLAIR

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

06/01/2023