JEREMIAH JERRY PARK DO Medical Doctor License verification

JEREMIAH JERRY PARK DO

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****83

License Status

NOT RENEWED

Business

First Name

JEREMIAH JERRY

Last Name

PARK

Suffix

Business Name

JEREMIAH JERRY PARK DO

Original Issue Date

08/09/1993

Effective Date

08/09/1993

Expiration Date

07/31/2002

City

ROUND LAKE BEACH

State

Zip

60073

County

LAKE

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/09/2006

Case Number

1994004400

Action

Reprimand

Discipline Start Date

12/11/1997

Discipline Reason

Prescribed a Schedule II controlled substance to one patient on a non-triplicate prescription form for a prescription filled in Wisconsin which does not have a triplicate prescription reporting system.