DIPAN J SHAH 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

DIPAN J

Last Name

SHAH

Suffix

Business Name

DIPAN J SHAH MD

Original Issue Date

04/23/1998

Effective Date

04/23/1998

Expiration Date

07/31/2005

City

ALEDO

State

Zip

61231

County

MERCER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/09/2006