JASON J LARSON 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

JASON

Middle

Last Name

LARSON

Business Name

JASON J LARSON

Original Issue Date

12/23/2002

Effective Date

12/23/2002

Expiration Date

07/31/2005

City

PEORIA

State

Zip

61637

County

PEORIA

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/09/2006