GEORGE C GUSTAFSON MD 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

GEORGE

Middle

Last Name

GUSTAFSON

Suffix

Business Name

GEORGE C GUSTAFSON MD

Original Issue Date

05/14/1999

Effective Date

05/14/1999

Expiration Date

07/31/2005

City

MOKENA

State

Zip

60448

County

WILL

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/07/2011