TODD CHARLES PETERSON DO 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

Title

First Name

TODD

Middle

CHARLES

Last Name

PETERSON

Business Name

TODD CHARLES PETERSON DO

Original Issue Date

04/22/2014

Effective Date

04/22/2014

Expiration Date

07/31/2017

City

SPRINGFIELD

State

Zip

62794

County

SANGAMON

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

Ever Disciplined

LastModifiedDate

11/01/2017