CHARLES GILLESPIE BOLAND MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****21

License Status

NOT RENEWED

Business

Title

First Name

CHARLES

Middle

GILLESPIE

Last Name

BOLAND

Business Name

CHARLES GILLESPIE BOLAND MD

Original Issue Date

04/09/2019

Effective Date

04/09/2019

Expiration Date

09/30/2020

City

PEORIA

State

Zip

61637

County

PEORIA

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/14/2021