BRIAN DAVID CARLSON Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****30

License Status

NOT RENEWED

Business

First Name

BRIAN

Middle

DAVID

Last Name

CARLSON

Business Name

BRIAN DAVID CARLSON

Original Issue Date

07/29/2009

Effective Date

07/29/2009

Expiration Date

07/31/2011

City

OLYMPIA FIELDS

State

Zip

60461

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/10/2011