DAVID T GOUGH MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****03

License Status

NOT RENEWED

Business

First Name

DAVID T

Last Name

GOUGH

Suffix

Business Name

DAVID T GOUGH MD

Original Issue Date

10/19/1984

Effective Date

10/19/1984

Expiration Date

07/31/1987

City

PEORIA

State

Zip

61637

County

PEORIA

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

09/26/2006