EDWARD L P SHACKLEFORD DO Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036093264

License Status

ACTIVE

Business

First Name

EDWARD L P

Last Name

SHACKLEFORD

Suffix

Business Name

EDWARD L P SHACKLEFORD DO

Original Issue Date

06/20/1996

Effective Date

07/08/2023

Expiration Date

07/31/2026

City

GURNEE

State

Zip

60031

County

LAKE

Ever Disciplined

LastModifiedDate

07/08/2023