FRED E BRAASTAD MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****70

License Status

NOT RENEWED

Business

First Name

FRED E

Last Name

BRAASTAD

Suffix

Business Name

FRED E BRAASTAD MD

Original Issue Date

03/17/1988

Effective Date

07/24/2017

Expiration Date

09/30/2020

City

PEORIA

State

Zip

61614

County

PEORIA

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/14/2021