PETER A TRACE MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****14

License Status

NOT RENEWED

Business

First Name

PETER A

Last Name

TRACE

Suffix

Business Name

PETER A TRACE MD

Original Issue Date

01/01/1997

Effective Date

05/15/2017

Expiration Date

09/30/2020

City

JACKSONVILLE

State

Zip

62650

County

MORGAN

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/14/2021