JOHN RYAN LIDVALL MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****75

License Status

ACTIVE

Business

First Name

JOHN

Middle

RYAN

Last Name

LIDVALL

Suffix

Business Name

JOHN RYAN LIDVALL MD

Original Issue Date

06/14/2013

Effective Date

06/16/2023

Expiration Date

07/31/2026

City

DUNLAP

State

Zip

61525

County

PEORIA

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

06/16/2023