AUSTIN DANIEL STREET MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****56

License Status

NOT RENEWED

Business

First Name

AUSTIN

Middle

DANIEL

Last Name

STREET

Suffix

Business Name

AUSTIN DANIEL STREET MD

Original Issue Date

06/02/2011

Effective Date

06/02/2011

Expiration Date

07/31/2014

City

ALTON

State

Zip

62002

County

MADISON

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/17/2014