JONATHAN WILLIAM HEIDT MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****62

License Status

CANCELLED

Business

Title

First Name

JONATHAN

Middle

WILLIAM

Last Name

HEIDT

Business Name

JONATHAN WILLIAM HEIDT MD

Original Issue Date

11/16/2009

Effective Date

11/16/2009

Expiration Date

07/31/2011

City

ST LOUIS

State

Zip

63123

County

MISSOURI

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/07/2011