CHARLES EDWARD MONTGOMERY MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036039308

License Status

NOT RENEWED

Business

First Name

CHARLES EDWARD

Last Name

MONTGOMERY

Suffix

Business Name

CHARLES EDWARD MONTGOMERY MD

Original Issue Date

08/17/1964

Effective Date

05/05/2011

Expiration Date

07/31/2014

City

PEORIA

State

Zip

61614

County

PEORIA

Ever Disciplined

LastModifiedDate

11/17/2014