BRIAN ROBERT LONG MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****44

License Status

NOT RENEWED

Business

First Name

BRIAN

Middle

ROBERT

Last Name

LONG

Suffix

Business Name

BRIAN ROBERT LONG MD

Original Issue Date

07/14/2003

Effective Date

07/14/2003

Expiration Date

07/31/2008

City

CHICAGO

State

Zip

60607

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/06/2008