KIRK BRADLEY JENSEN MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****60

License Status

NOT RENEWED

Business

First Name

KIRK BRADLEY

Last Name

JENSEN

Suffix

Business Name

KIRK BRADLEY JENSEN MD

Original Issue Date

07/07/2004

Effective Date

07/08/2008

Expiration Date

07/31/2011

City

BLOOMINGTON

State

Zip

61701

County

MCLEAN

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/10/2011