RICHARD W CARLSON MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****59

License Status

NOT RENEWED

Business

First Name

RICHARD W

Last Name

CARLSON

Suffix

Business Name

RICHARD W CARLSON MD

Original Issue Date

08/18/1992

Effective Date

08/18/1992

Expiration Date

07/31/1996

City

PEORIA

State

Zip

61657

County

PEORIA

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

09/26/2006