JERALD MILES PETERSON MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****97

License Status

NOT RENEWED

Business

Title

First Name

JERALD

Middle

MILES

Last Name

PETERSON

Business Name

JERALD MILES PETERSON MD

Original Issue Date

08/07/2014

Effective Date

08/07/2014

Expiration Date

07/31/2017

City

MINNEAPOLIS

State

Zip

55422

County

MINNESOTA

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/01/2017