ETHAN JEROME MALTZ MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****18

License Status

ACTIVE

Business

Title

First Name

ETHAN

Middle

JEROME

Last Name

MALTZ

Business Name

ETHAN JEROME MALTZ MD

Original Issue Date

08/05/2024

Effective Date

08/05/2024

Expiration Date

07/31/2026

City

DUNLAP

State

Zip

61525

County

PEORIA

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

08/05/2024