JUSTIN R JOHNSEN MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****17

License Status

NOT RENEWED

Business

Title

First Name

JUSTIN

Middle

Last Name

JOHNSEN

Business Name

JUSTIN R JOHNSEN MD

Original Issue Date

10/13/2015

Effective Date

06/12/2017

Expiration Date

09/30/2020

City

SALT LAKE CITY

State

Zip

84109

County

SANGAMON

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/14/2021