DENNIS OWEN BACKSTROM MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****17

License Status

NOT RENEWED

Business

First Name

DENNIS OWEN

Last Name

BACKSTROM

Suffix

Business Name

DENNIS OWEN BACKSTROM MD

Original Issue Date

08/15/2005

Effective Date

08/15/2005

Expiration Date

07/31/2008

City

JACKSONVILLE

State

Zip

62650

County

MORGAN

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/05/2020