ROBERT CARSON RUSSELL DO Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****49

License Status

ACTIVE

Business

Title

First Name

ROBERT

Middle

CARSON

Last Name

RUSSELL

Business Name

ROBERT CARSON RUSSELL DO

Original Issue Date

12/12/2024

Effective Date

12/12/2024

Expiration Date

07/31/2026

City

PEORIA

State

Zip

61637

County

PEORIA

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

12/12/2024