J ANTONIO G LOPEZ 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

First Name

J ANTONIO G

Last Name

LOPEZ

Business Name

J ANTONIO G LOPEZ

Original Issue Date

06/06/1995

Effective Date

06/06/1995

Expiration Date

07/31/2005

City

SPRINGFIELD

State

Zip

62794

County

SANGAMON

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/09/2006