FERNANDO RAFAEL MEDINA CARBONELL MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****68

License Status

ACTIVE

Business

Title

First Name

FERNANDO

Middle

RAFAEL

Last Name

MEDINA CARBONELL

Business Name

FERNANDO RAFAEL MEDINA CARBONELL MD

Original Issue Date

06/08/2023

Effective Date

06/08/2023

Expiration Date

07/31/2026

City

EDWARDSVILLE

State

Zip

62025

County

MADISON

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

06/02/2021