BRIAN WAYNE GOELITZ MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****67

License Status

NOT RENEWED

Business

First Name

BRIAN

Middle

WAYNE

Last Name

GOELITZ

Suffix

Business Name

BRIAN WAYNE GOELITZ MD

Original Issue Date

04/09/2004

Effective Date

07/23/2008

Expiration Date

07/31/2011

City

BYRON

State

Zip

61010

County

OGLE

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/10/2011