PETER OBOURN (Credential# 1424777) is licensed (Controlled Substance Registration for Practitioner) with Connecticut Department of Consumer Protection. The license effective date is May 31, 2017. The license expiration date date is February 28, 2019. The license status is LAPSED.
PETER OBOURN is licensed with the Department of Consumer Protection of Connecticut. The credential number is #CSP.0065452. The credential type is controlled substance registration for practitioner. The effective date is May 31, 2017. The expiration date is February 28, 2019. The business address is 94 Buckhorn Rd, Bloomsburg, PA 17815-9705. The current status is lapsed.
| Licensee Name | PETER OBOURN |
| Credential ID | 1424777 |
| Credential Number | CSP.0065452 |
| Credential Type | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER |
| Business Address |
94 Buckhorn Rd Bloomsburg PA 17815-9705 |
| Business Type | INDIVIDUAL |
| Status | LAPSED |
| Active | 1 |
| Issue Date | 2017-05-31 |
| Effective Date | 2017-05-31 |
| Expiration Date | 2019-02-28 |
| Refresh Date | 2019-03-06 |
| ID | Credential Code | Credential Type | Issue | Term | Status |
|---|---|---|---|---|---|
| 1488719 | 1.058114-RES | Resident Physician | 2017-07-01 | 2017-07-01 - 2018-06-30 | INACTIVE |
| Street Address | 94 BUCKHORN RD |
| City | BLOOMSBURG |
| State | PA |
| Zip Code | 17815-9705 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Michael H Queen | 1103 Cherry Hill Rd, Bloomsburg, PA 17815 | Professional Engineer | 2020-02-01 ~ 2021-01-31 |
| Matthew J Vertucci | 3029 Woods Edge Dr, Bloomsburg, PA 17815 | Professional Engineer | 2020-02-01 ~ 2021-01-31 |
| Gino J Mongelluzzo | 213 W 3rd St, Bloomsburg, PA 17815 | Resident Physician | 2015-06-25 ~ 2019-06-30 |
| Gerald R Bodman | 98 Church Roadr, Bloomsburg, PA 17815 | Professional Engineer | 2003-02-01 ~ 2004-01-31 |
| Tracie A Wood | 117 Hemlock Lane, Bloomsburg, PA 17815 | Physical Therapist | 2008-10-21 ~ 2009-12-31 |
| Helen J Lough | P.o. Box 357, Bloomsburg, PA 17815 | Licensed Practical Nurse | 2004-09-13 ~ 2005-09-30 |
| Jeffery O Skjoldal Jr. | 76 Kile Drive, Bloomsburg, PA 17815 | Asbestos Abatement Supervisor | 2004-01-26 ~ 2004-04-30 |
| Leesa J Masteller | Rd #3 Boc 195, Bloomburg, PA 17815 | Physical Therapist | ~ 1999-02-28 |
| Alice F Wilson | 134 East 12th St, Bloomsburg, PA 17815 | Registered Nurse | 1992-06-25 ~ 1993-05-31 |
| Joseph Shovlin Md | 1250 Chestnut Street, Bloomburg, PA 17815 | Controlled Substance Registration for Practitioner | 1998-04-02 ~ 1999-02-28 |
| Find all Licenses in zip 17815 | |||
| City | BLOOMSBURG |
| Zip Code | 17815 |
| License Type | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER |
| License Type + County | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER + BLOOMSBURG |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Peter John Obourn | 55 Trumbull Street, Hartford, CT 06103 | Physician/surgeon | 2018-05-01 ~ 2018-10-31 |
| Peter Lee Kim | 20 Front St Apt 501, Hartford, CT 06103-2851 | Controlled Substance Registration for Practitioner | 2020-06-04 ~ 2021-02-28 |
| Peter N. Le | 202 Turtle Bay Dr, Branford, CT 06405-4904 | Controlled Substance Registration for Practitioner | 2013-03-01 ~ 2015-02-28 |
| Peter S Yoo | 333 Cedar St Fmb 121, New Haven, CT 06510-3206 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Peter M Petrillo | 4 9th Ave, Branford, CT 06405 | Controlled Substance Registration for Practitioner | 2013-03-01 ~ 2015-02-28 |
| Peter Jameson Md | Po Box 448, Bridgewater, CT 06752 | Controlled Substance Registration for Practitioner | 2009-03-01 ~ 2011-02-28 |
| Peter Bonis Md | 209 2nd Ave, Milford, CT 06460 | Controlled Substance Registration for Practitioner | 1998-03-01 ~ 1999-02-28 |
| Peter B Schneidau | Po Box 6, Darien, CT 06820 | Controlled Substance Registration for Practitioner | 2007-03-01 ~ 2008-02-29 |
| W Peter Reyelt Md | Po Box 206, Sharon, CT 06069-0206 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Peter R Later Do | 64 Windward Way, Waterford, CT 06385 | Controlled Substance Registration for Practitioner | 2009-03-01 ~ 2011-02-28 |
Please comment or provide details below to improve the information on PETER OBOURN.
| Data Provider | Connecticut Department of Consumer Protection |
| Jurisdiction | Connecticut |
| Related Datasets | Connecticut Business Registrations, Connecticut Child Care Facilities |
This dataset includes 1.41 million licenses issued wtih Connecticut Department of Consumer Protection (TDLR).