ERIC RUSSELL SHIVES MD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125051922

License Status

EXPIRED

Business

First Name

ERIC

Middle

RUSSELL

Last Name

SHIVES

Suffix

Business Name

ERIC RUSSELL SHIVES MD

Original Issue Date

07/01/2006

Effective Date

07/01/2006

Expiration Date

06/30/2009

City

BELLEVILLE

State

Zip

62220

County

SAINT CLAIR

Specialty/Qualifier

Family Medicine

Ever Disciplined

LastModifiedDate

07/15/2009