DAVID L SHAW MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****23

License Status

NOT RENEWED

Business

First Name

DAVID L

Last Name

SHAW

Suffix

Business Name

DAVID L SHAW MD

Original Issue Date

09/16/1996

Effective Date

09/16/1996

Expiration Date

07/31/2002

City

ROCKFORD

State

Zip

61104

County

WINNEBAGO

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/09/2006