RONALD EDWIN MATTISON 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

RONALD

Middle

EDWIN

Last Name

MATTISON

Business Name

RONALD EDWIN MATTISON

Original Issue Date

07/03/2007

Effective Date

05/15/2008

Expiration Date

07/31/2011

City

CARBONDALE

State

Zip

62901

County

JACKSON

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/10/2011