RAFAEL JESUS FERNANDEZ 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

RAFAEL JESUS

Last Name

FERNANDEZ

Suffix

Business Name

RAFAEL JESUS FERNANDEZ MD

Original Issue Date

05/23/1996

Effective Date

05/23/1996

Expiration Date

07/31/1999

City

PEORIA

State

Zip

61605

County

PEORIA

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/05/2020