EVELENA PATRICE ONTIVEROS MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****34

License Status

ACTIVE

Business

Title

First Name

EVELENA

Middle

PATRICE

Last Name

ONTIVEROS

Business Name

EVELENA PATRICE ONTIVEROS MD

Original Issue Date

07/31/2017

Effective Date

04/13/2023

Expiration Date

07/31/2026

City

DECATUR

State

Zip

62526

County

MACON

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/13/2023