GARRY DEAN WEIDE DO Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****25

License Status

NOT RENEWED

Business

Title

First Name

GARRY

Middle

DEAN

Last Name

WEIDE

Business Name

GARRY DEAN WEIDE DO

Original Issue Date

03/20/2014

Effective Date

07/18/2014

Expiration Date

07/31/2017

City

URBANA

State

Zip

61801

County

CHAMPAIGN

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/01/2017