DAVID LEE MATLOCK Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****02

License Status

NOT RENEWED

Business

First Name

DAVID

Middle

LEE

Last Name

MATLOCK

Business Name

DAVID LEE MATLOCK

Original Issue Date

07/29/2008

Effective Date

06/06/2011

Expiration Date

07/31/2014

City

DUNLAP

State

Zip

61525

County

PEORIA

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/17/2014