DEANNE LONG Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****79

License Status

NOT RENEWED

Business

First Name

DEANNE

Last Name

LONG

Business Name

DEANNE LONG

Original Issue Date

05/18/2000

Effective Date

05/18/2000

Expiration Date

07/31/2002

City

PEORIA

State

Zip

61603

County

PEORIA

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/09/2006