EZRA DAVID SHAPIRO MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****22

License Status

CANCELLED

Business

First Name

EZRA DAVID

Last Name

SHAPIRO

Suffix

Business Name

EZRA DAVID SHAPIRO MD

Original Issue Date

01/01/1997

Expiration Date

07/31/1990

City

PEORIA

State

Zip

61603

County

PEORIA

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

09/26/2006