MANUEL VALDIVIESO 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

First Name

MANUEL

Last Name

VALDIVIESO

Suffix

Business Name

MANUEL VALDIVIESO MD

Original Issue Date

04/01/2003

Effective Date

04/01/2003

Expiration Date

07/31/2008

City

SPRINGFIELD

State

Zip

62794

County

SANGAMON

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/12/2017