JASON ALLAN BERGANDI Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****26

License Status

NOT RENEWED

Business

First Name

JASON

Middle

ALLAN

Last Name

BERGANDI

Business Name

JASON ALLAN BERGANDI

Original Issue Date

07/13/2005

Effective Date

04/13/2011

Expiration Date

07/31/2014

City

PERU

State

Zip

61354

County

LA SALLE

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/17/2014

Case Number

2007008826

Action

Suspension

Discipline Start Date

05/08/2012

Discipline Reason

for failure to comply with terms and conditions of agreement with Department.