DAVID JANTZEN MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****04

License Status

NOT RENEWED

Business

Title

First Name

DAVID

Last Name

JANTZEN

Business Name

DAVID JANTZEN MD

Original Issue Date

06/03/2015

Effective Date

06/01/2017

Expiration Date

09/30/2020

City

PEORIA

State

Zip

61603

County

PEORIA

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/14/2021