GRANT DOUGLAS SYVERSON MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****03

License Status

NOT RENEWED

Business

Title

First Name

GRANT

Middle

DOUGLAS

Last Name

SYVERSON

Business Name

GRANT DOUGLAS SYVERSON MD

Original Issue Date

07/02/2014

Effective Date

07/02/2014

Expiration Date

07/31/2017

City

MADISON

State

Zip

53711

County

WISCONSIN

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

Ever Disciplined

LastModifiedDate

11/01/2017