CARL W SODERSTROM MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****82

License Status

CANCELLED

Business

First Name

CARL W

Last Name

SODERSTROM

Suffix

Business Name

CARL W SODERSTROM MD

Original Issue Date

08/19/1996

Effective Date

08/19/1996

Expiration Date

07/31/2008

City

PEORIA

State

Zip

61614

County

PEORIA

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/05/2020