ENRIQUE PERALTA MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****45

License Status

ACTIVE

Business

First Name

ENRIQUE

Last Name

PERALTA

Suffix

Business Name

ENRIQUE PERALTA MD

Original Issue Date

08/13/2004

Effective Date

04/20/2023

Expiration Date

07/31/2026

City

SWANSEA

State

Zip

62226

County

SAINT CLAIR

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/20/2023