CARLOS MIGUEL DACOSTA MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****86

License Status

NOT RENEWED

Business

First Name

CARLOS MIGUEL

Last Name

DACOSTA

Suffix

Business Name

CARLOS MIGUEL DACOSTA MD

Original Issue Date

12/11/1986

Effective Date

12/11/1986

Expiration Date

07/31/1987

City

DIXON

State

Zip

62401

County

EFFINGHAM

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

09/26/2006