CHARLES JOSEPH DIETZEN MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****11

License Status

CANCELLED

Business

First Name

CHARLES JOSEPH

Last Name

DIETZEN

Suffix

Business Name

CHARLES JOSEPH DIETZEN MD

Original Issue Date

05/29/1996

Effective Date

05/29/1996

Expiration Date

07/31/1999

City

CARBONDALE

State

Zip

62901

County

JACKSON

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

09/26/2006