LARA JOSAN THEOBALD 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

LARA

Middle

JOSAN

Last Name

THEOBALD

Suffix

Business Name

LARA JOSAN THEOBALD MD

Original Issue Date

03/20/2007

Effective Date

05/22/2008

Expiration Date

07/31/2011

City

NAPERVILLE

State

Zip

60563

County

DUPAGE

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/10/2011