TODD J PETERSEN Physician Assistant License verification

Business Entity

ACTIVE

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****89

License Status

ACTIVE

Business

First Name

TODD

Middle

Last Name

PETERSEN

Business Name

TODD J PETERSEN

Original Issue Date

08/31/2006

Effective Date

01/06/2026

Expiration Date

03/01/2028

City

SPRINGFIELD

State

Zip

62703

County

SANGAMON

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/06/2026