LANCELOT K TIN MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****12

License Status

NOT RENEWED

Business

First Name

LANCELOT K

Last Name

TIN

Suffix

Business Name

LANCELOT K TIN MD

Original Issue Date

11/07/1984

Effective Date

11/07/1984

Expiration Date

07/31/1987

City

BLOOMINGTON

State

Zip

61701

County

MCLEAN

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

09/26/2006