DANE MARC LARSEN MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****27

License Status

NOT RENEWED

Business

First Name

DANE MARC

Last Name

LARSEN

Suffix

Business Name

DANE MARC LARSEN MD

Original Issue Date

11/09/1998

Effective Date

11/09/1998

Expiration Date

07/31/2002

City

BELLEVILLE

State

Zip

62226

County

SAINT CLAIR

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/09/2006