JACQUELINE LONG MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****08

License Status

NOT RENEWED

Business

First Name

JACQUELINE

Last Name

LONG

Suffix

Business Name

JACQUELINE LONG MD

Original Issue Date

09/12/1986

Effective Date

09/12/1986

Expiration Date

07/31/1990

City

ST LOUIS

State

Zip

63017

County

MISSOURI

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

09/26/2006