JACK E SHALLEY MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****16

License Status

NOT RENEWED

Business

First Name

JACK E

Last Name

SHALLEY

Suffix

Business Name

JACK E SHALLEY MD

Original Issue Date

10/20/1988

Effective Date

10/20/1988

Expiration Date

07/31/1996

City

SPRINGFIELD

State

Zip

62713

County

SANGAMON

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

09/26/2006