JOHN MICHAEL BALLESTER MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****31

License Status

NOT RENEWED

Business

First Name

JOHN

Middle

MICHAEL

Last Name

BALLESTER

Suffix

Business Name

JOHN MICHAEL BALLESTER MD

Original Issue Date

05/12/1999

Effective Date

05/12/1999

Expiration Date

07/31/2002

City

SPRINGFIELD

State

Zip

62769

County

SANGAMON

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/09/2006