ALICE S PENROSE MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****05

License Status

CANCELLED

Business

First Name

ALICE S

Last Name

PENROSE

Suffix

Business Name

ALICE S PENROSE MD

Original Issue Date

07/31/1990

Effective Date

07/31/1990

Expiration Date

07/31/2005

City

CHAMPAIGN

State

Zip

61820

County

CHAMPAIGN

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/09/2006