DAVID M COUNTRYMAN 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

DAVID

Middle

Last Name

COUNTRYMAN

Business Name

DAVID M COUNTRYMAN MD

Original Issue Date

12/08/2005

Effective Date

12/08/2005

Expiration Date

07/31/2008

City

GALESBURG

State

Zip

61401

County

KNOX

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/05/2020