JERRY VILLASENOR Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****23

License Status

ACTIVE

Business

First Name

JERRY

Last Name

VILLASENOR

Business Name

JERRY VILLASENOR

Original Issue Date

06/18/2004

Effective Date

07/29/2023

Expiration Date

07/31/2026

City

BERWYN

State

Zip

60402

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

07/29/2023