SAM A MOORE DO Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****28

License Status

ACTIVE

Business

First Name

SAM A

Last Name

MOORE

Suffix

Business Name

SAM A MOORE DO

Original Issue Date

11/07/2003

Effective Date

04/18/2023

Expiration Date

07/31/2026

City

BLOOMINGTON

State

Zip

61701

County

CHAMPAIGN

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/18/2023