DERRALYN M. HARRIS, M.D Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****28

License Status

NOT RENEWED

Business

First Name

DERRALYN

Middle

Last Name

HARRIS,

Suffix

M.D

Business Name

DERRALYN M. HARRIS, M.D

Original Issue Date

09/11/2000

Effective Date

09/11/2000

Expiration Date

07/31/2005

City

ROCKFORD

State

Zip

61104

County

WINNEBAGO

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/09/2006