CHRISTIAN LACELLE CARLSON MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****91

License Status

NOT RENEWED

Business

Title

First Name

CHRISTIAN

Middle

LACELLE

Last Name

CARLSON

Business Name

CHRISTIAN LACELLE CARLSON MD

Original Issue Date

12/18/2018

Effective Date

12/18/2018

Expiration Date

09/30/2020

City

ROCKFORD

State

Zip

61103

County

WINNEBAGO

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/14/2021