RYAN SEAN DIEDERICH MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****19

License Status

ACTIVE

Business

First Name

RYAN

Middle

SEAN

Last Name

DIEDERICH

Suffix

Business Name

RYAN SEAN DIEDERICH MD

Original Issue Date

07/07/2011

Effective Date

04/18/2023

Expiration Date

07/31/2026

City

GLEN CARBON

State

Zip

62034

County

MADISON

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/18/2023