BRENT C JOHNSON Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****37

License Status

ACTIVE

Business

First Name

BRENT

Middle

Last Name

JOHNSON

Business Name

BRENT C JOHNSON

Original Issue Date

06/03/2003

Effective Date

06/03/2023

Expiration Date

07/31/2026

City

PEORIA

State

Zip

61614

County

PEORIA

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

06/03/2023