ERIC W SHADLE MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****11

License Status

NOT RENEWED

Business

First Name

ERIC W

Last Name

SHADLE

Suffix

Business Name

ERIC W SHADLE MD

Original Issue Date

04/18/1989

Effective Date

04/18/1989

Expiration Date

07/31/2005

City

ROCKFORD

State

Zip

61104

County

WINNEBAGO

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/09/2006