BRIAN VERNON WIETHOP MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****02

License Status

NOT RENEWED

Business

First Name

BRIAN

Middle

VERNON

Last Name

WIETHOP

Suffix

Business Name

BRIAN VERNON WIETHOP MD

Original Issue Date

10/16/2001

Effective Date

09/25/2008

Expiration Date

07/31/2011

City

EDWARDSVILLE

State

Zip

62025

County

MADISON

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/10/2011