KENNETH A HALLER JR Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****46

License Status

NOT RENEWED

Business

First Name

KENNETH A

Last Name

HALLER JR

Business Name

KENNETH A HALLER JR

Original Issue Date

10/15/1986

Effective Date

10/15/1986

Expiration Date

07/31/2008

City

EAST ST LOUIS

State

Zip

62201

County

SAINT CLAIR

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/06/2008