BROCK L EIDE MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****07

License Status

NOT RENEWED

Business

First Name

BROCK L

Last Name

EIDE

Suffix

Business Name

BROCK L EIDE MD

Original Issue Date

05/02/1995

Effective Date

05/02/1995

Expiration Date

07/31/2002

City

CHICAGO

State

Zip

60617

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/09/2006