THERESE M WILSON MD 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

THERESE

Middle

Last Name

WILSON

Suffix

Business Name

THERESE M WILSON MD

Original Issue Date

08/21/1998

Effective Date

08/21/1998

Expiration Date

07/31/2002

City

PEORIA

State

Zip

61603

County

PEORIA

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/09/2006