ERIC WIDEBURG DO Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****22

License Status

ACTIVE

Business

Title

First Name

ERIC

Last Name

WIDEBURG

Business Name

ERIC WIDEBURG DO

Original Issue Date

07/31/2023

Effective Date

07/31/2023

Expiration Date

07/31/2026

City

WAUWATOSA

State

Zip

53226

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV

Ever Disciplined

LastModifiedDate

07/31/2023