SHANTI S YERRA Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****01

License Status

NOT RENEWED

Business

First Name

SHANTI S

Last Name

YERRA

Business Name

SHANTI S YERRA

Original Issue Date

12/04/1996

Effective Date

12/04/1996

Expiration Date

07/31/1999

City

PEORIA

State

Zip

61630

County

PEORIA

Controlled Substance Schedule

II III IV

Ever Disciplined

LastModifiedDate

09/26/2006