ENRIQUE PERALTA MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****07

License Status

NOT RENEWED

Business

First Name

ENRIQUE

Last Name

PERALTA

Suffix

Business Name

ENRIQUE PERALTA MD

Original Issue Date

07/23/2009

Effective Date

07/23/2009

Expiration Date

07/31/2011

City

MOUNT VERNON

State

Zip

62864

County

JEFFERSON

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/05/2020