JUAN ISRAEL GAITAN RUEDA MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****09

License Status

NOT RENEWED

Business

Title

First Name

JUAN

Middle

ISRAEL

Last Name

GAITAN RUEDA

Business Name

JUAN ISRAEL GAITAN RUEDA MD

Original Issue Date

11/13/2013

Effective Date

04/29/2014

Expiration Date

07/31/2017

City

MOUNT VERNON

State

Zip

62864

County

JEFFERSON

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/01/2017