BRIAN WADE MECKLENBURG MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****23

License Status

ACTIVE

Business

Title

First Name

BRIAN

Middle

WADE

Last Name

MECKLENBURG

Business Name

BRIAN WADE MECKLENBURG MD

Original Issue Date

08/03/2019

Effective Date

07/23/2023

Expiration Date

07/31/2026

City

LOVES PARK

State

Zip

61111

County

WINNEBAGO

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

07/23/2023