EDWARD L P SHACKLEFORD DO Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125032525

License Status

EXPIRED

Business

First Name

EDWARD L P

Last Name

SHACKLEFORD

Suffix

Business Name

EDWARD L P SHACKLEFORD DO

Original Issue Date

05/11/1995

Effective Date

05/11/1995

Expiration Date

06/30/1998

City

CHICAGO

State

Zip

60615

County

COOK

Specialty/Qualifier

Emergency Medicine

Ever Disciplined

LastModifiedDate

09/22/2006