DANIEL G DOMJAN Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****55

License Status

NOT RENEWED

Business

First Name

DANIEL

Middle

Last Name

DOMJAN

Business Name

DANIEL G DOMJAN

Original Issue Date

07/17/2001

Effective Date

07/17/2001

Expiration Date

07/31/2002

City

BENTON

State

Zip

62812

County

FRANKLIN

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/09/2006