IVAN DIAZ MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****95

License Status

CANCELLED

Business

First Name

IVAN

Last Name

DIAZ

Suffix

Business Name

IVAN DIAZ MD

Original Issue Date

06/28/2004

Effective Date

06/28/2004

Expiration Date

07/31/2008

City

BELVIDERE

State

Zip

61008

County

BOONE

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/17/2008