DWIGHT F PENTZIEN JR DO Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****64

License Status

ACTIVE

Business

Title

First Name

DWIGHT F

Last Name

PENTZIEN JR

Business Name

DWIGHT F PENTZIEN JR DO

Original Issue Date

07/11/1995

Effective Date

04/06/2023

Expiration Date

07/31/2026

City

MATTOON

State

Zip

61938

County

COLES

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/06/2023