RAFAEL M DE LA CRUZ Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****16

License Status

ACTIVE

Business

First Name

RAFAEL

Middle

Last Name

DE LA CRUZ

Business Name

RAFAEL M DE LA CRUZ

Original Issue Date

03/24/2005

Effective Date

08/01/2023

Expiration Date

07/31/2026

City

ALTON

State

Zip

62002

County

MADISON

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

08/01/2023