LEO V WILLETT JR
Physician/surgeon


Address: 57 Middlefield Rd, Durham, CT 06422

LEO V WILLETT JR (Credential# 541239) is licensed (Physician/surgeon) with Connecticut Department of Consumer Protection. The license effective date is April 27, 2005. The license expiration date date is June 30, 2006. The license status is INACTIVE.

Business Overview

LEO V WILLETT JR is licensed with the Department of Consumer Protection of Connecticut. The credential number is #1.014803. The credential type is physician/surgeon. The effective date is April 27, 2005. The expiration date is June 30, 2006. The business address is 57 Middlefield Rd, Durham, CT 06422. The current status is inactive.

Basic Information

Licensee Name LEO V WILLETT JR
Credential ID 541239
Credential Number 1.014803
Credential Type Physician/Surgeon
Business Address 57 Middlefield Rd
Durham
CT 06422
Business Type INDIVIDUAL
Status INACTIVE - LAPSED DUE TO NON-RENEWAL
Issue Date 1970-12-14
Effective Date 2005-04-27
Expiration Date 2006-06-30
Refresh Date 2009-07-08

Other licenses

ID Credential Code Credential Type Issue Term Status
150751 CSP.0002645 CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER 1999-03-01 - 2000-02-28 INACTIVE

Office Location

Street Address 57 MIDDLEFIELD RD
City DURHAM
State CT
Zip Code 06422

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City DURHAM
Zip Code 06422
License Type Physician/Surgeon
License Type + County Physician/Surgeon + DURHAM

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Dataset Information

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).

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