LIAWATY HO MD 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

LIAWATY

Last Name

Suffix

Business Name

LIAWATY HO MD

Original Issue Date

06/07/2005

Effective Date

06/07/2005

Expiration Date

07/31/2008

City

PEORIA

State

Zip

61637

County

PEORIA

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/06/2008