BRIAN WOODFORD PETERSEN MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****63

License Status

NOT RENEWED

Business

Title

First Name

BRIAN

Middle

WOODFORD

Last Name

PETERSEN

Business Name

BRIAN WOODFORD PETERSEN MD

Original Issue Date

04/06/2016

Effective Date

04/06/2016

Expiration Date

07/31/2017

City

CHICAGO

State

Zip

60611

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV

Ever Disciplined

LastModifiedDate

11/01/2017