DANIEL R FASSETT MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****11

License Status

NOT RENEWED

Business

Title

First Name

DANIEL

Middle

Last Name

FASSETT

Business Name

DANIEL R FASSETT MD

Original Issue Date

02/08/2007

Effective Date

06/15/2020

Expiration Date

07/31/2023

City

PEORIA

State

Zip

61603

County

PEORIA

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/30/2023