JEFFERY D LONG 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

Title

First Name

JEFFERY

Middle

Last Name

LONG

Business Name

JEFFERY D LONG MD

Original Issue Date

10/12/1993

Effective Date

10/12/1993

Expiration Date

07/31/1996

City

MANTENO

State

Zip

60941

County

KANKAKEE

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/05/2020