ETHAN PATRICK BERG DO Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****72

License Status

ACTIVE

Business

Title

First Name

ETHAN

Middle

PATRICK

Last Name

BERG

Business Name

ETHAN PATRICK BERG DO

Original Issue Date

04/06/2020

Effective Date

06/22/2023

Expiration Date

07/31/2026

City

DECATUR

State

Zip

62526

County

MACON

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

06/22/2023