MATTHEW LOUIS BLACK 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

MATTHEW LOUIS

Last Name

BLACK

Suffix

Business Name

MATTHEW LOUIS BLACK MD

Original Issue Date

08/07/1996

Effective Date

08/07/1996

Expiration Date

07/31/2005

City

URBANA

State

Zip

61801

County

CHAMPAIGN

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/09/2006