BO MARCUS GUSTAFSSON MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****31

License Status

ACTIVE

Business

Title

First Name

Middle

MARCUS

Last Name

GUSTAFSSON

Business Name

BO MARCUS GUSTAFSSON MD

Original Issue Date

06/11/2021

Effective Date

08/03/2023

Expiration Date

07/31/2026

City

PEORIA

State

Zip

61605

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

08/03/2023