FREDERICK DWAYNE JOHNSON 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

FREDERICK

Middle

DWAYNE

Last Name

JOHNSON

Suffix

Business Name

FREDERICK DWAYNE JOHNSON MD

Original Issue Date

07/05/2013

Effective Date

07/05/2013

Expiration Date

07/31/2014

City

PEORIA

State

Zip

61615

County

PEORIA

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/17/2014