LAURA M PITTMAN 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

LAURA

Middle

Last Name

PITTMAN

Business Name

LAURA M PITTMAN

Original Issue Date

06/16/2005

Effective Date

06/30/2008

Expiration Date

07/31/2011

City

ROCKFORD

State

Zip

61103

County

WINNEBAGO

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/10/2011