GARRETT BRENT SHACKLETON MD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125068578

License Status

EXPIRED

Business

Title

First Name

GARRETT

Middle

BRENT

Last Name

SHACKLETON

Business Name

GARRETT BRENT SHACKLETON MD

Original Issue Date

06/26/2019

Effective Date

06/26/2019

Expiration Date

06/25/2021

City

SPRINGFIELD

State

Zip

62701

County

SANGAMON

Specialty/Qualifier

General Surgery

Ever Disciplined

LastModifiedDate

10/11/2022