JACK D HANSEN MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****03

License Status

NOT RENEWED

Business

First Name

JACK D

Last Name

HANSEN

Suffix

Business Name

JACK D HANSEN MD

Original Issue Date

01/01/1997

Effective Date

06/09/2014

Expiration Date

07/31/2017

City

DEER PARK

State

Zip

60010

County

LAKE

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/01/2017