GERALD ROGER PETERSON MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****89

License Status

NOT RENEWED

Business

First Name

GERALD ROGER

Last Name

PETERSON

Suffix

Business Name

GERALD ROGER PETERSON MD

Original Issue Date

01/01/1997

Effective Date

06/03/2011

Expiration Date

07/31/2014

City

BELVIDERE

State

Zip

61008

County

BOONE

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/17/2014