SALLY L PETITO MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****81

License Status

CANCELLED

Business

First Name

SALLY L

Last Name

PETITO

Suffix

Business Name

SALLY L PETITO MD

Original Issue Date

03/29/1989

Effective Date

03/29/1989

Expiration Date

07/31/2002

City

ALTON

State

Zip

62002

County

MADISON

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/09/2006