JUAN C DOMINGUEZ 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

JUAN

Middle

Last Name

DOMINGUEZ

Business Name

JUAN C DOMINGUEZ

Original Issue Date

09/15/1998

Effective Date

09/15/1998

Expiration Date

07/31/1999

City

DECATUR

State

Zip

62526

County

MACON

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

09/26/2006