DAMIAN W GRIVETTI 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

Title

First Name

DAMIAN

Middle

Last Name

GRIVETTI

Business Name

DAMIAN W GRIVETTI MD

Original Issue Date

04/02/2009

Effective Date

07/28/2014

Expiration Date

07/31/2017

City

PERU

State

Zip

61354

County

LA SALLE

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/05/2020