DAVID OWEN MANIGOLD MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****13

License Status

NOT RENEWED

Business

First Name

DAVID OWEN

Last Name

MANIGOLD

Suffix

Business Name

DAVID OWEN MANIGOLD MD

Original Issue Date

01/01/1997

Effective Date

05/19/2020

Expiration Date

07/31/2023

City

OTTAWA

State

Zip

61350

County

LA SALLE

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/30/2023