BRUCE PATTEN PETERSON MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****12

License Status

NOT RENEWED

Business

First Name

BRUCE PATTEN

Last Name

PETERSON

Suffix

Business Name

BRUCE PATTEN PETERSON MD

Original Issue Date

01/01/1997

Effective Date

10/12/2017

Expiration Date

09/30/2020

City

ROSCOE

State

Zip

61073

County

WINNEBAGO

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/14/2021