JACK MARSHALL BERGSTEIN MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****43

License Status

NOT RENEWED

Business

First Name

JACK MARSHALL

Last Name

BERGSTEIN

Suffix

Business Name

JACK MARSHALL BERGSTEIN MD

Original Issue Date

09/15/1997

Effective Date

09/15/1997

Expiration Date

07/31/1999

City

PEORIA

State

Zip

61603

County

PEORIA

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

09/26/2006