DALE BAMBI JOHNSON MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****17

License Status

ACTIVE

Business

Title

First Name

DALE

Middle

BAMBI

Last Name

JOHNSON

Business Name

DALE BAMBI JOHNSON MD

Original Issue Date

09/18/2023

Effective Date

09/18/2023

Expiration Date

07/31/2026

City

QUINCY

State

Zip

62301

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

09/18/2023