CARL ROBERT JOHNSON MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****84

License Status

NOT RENEWED

Business

First Name

CARL ROBERT

Last Name

JOHNSON

Suffix

Business Name

CARL ROBERT JOHNSON MD

Original Issue Date

01/01/1997

Effective Date

07/24/2017

Expiration Date

09/30/2020

City

MATTOON

State

Zip

61938

County

COLES

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/14/2021