WALTER ALBERT BLACK MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****04

License Status

NOT RENEWED

Business

First Name

WALTER ALBERT

Last Name

BLACK

Suffix

Business Name

WALTER ALBERT BLACK MD

Original Issue Date

01/01/1997

Expiration Date

09/01/1982

City

PEORIA

State

Zip

61603

County

PEORIA

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

09/26/2006