JUSTIN BRADLEY LONG MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****73

License Status

NOT RENEWED

Business

Title

First Name

JUSTIN

Middle

BRADLEY

Last Name

LONG

Business Name

JUSTIN BRADLEY LONG MD

Original Issue Date

06/18/2014

Effective Date

06/18/2014

Expiration Date

07/31/2017

City

CHICAGO

State

Zip

60611

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/01/2017