BRIAN RICHARD CARLSON MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****40

License Status

NOT RENEWED

Business

First Name

BRIAN

Middle

RICHARD

Last Name

CARLSON

Suffix

Business Name

BRIAN RICHARD CARLSON MD

Original Issue Date

05/09/2002

Effective Date

05/09/2002

Expiration Date

07/31/2008

City

PEORIA

State

Zip

61605

County

PEORIA

Controlled Substance Schedule

Ever Disciplined

LastModifiedDate

04/05/2020