SHANNON B RIDER 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

SHANNON

Middle

Last Name

RIDER

Business Name

SHANNON B RIDER

Original Issue Date

04/29/2002

Effective Date

04/29/2002

Expiration Date

07/31/2005

City

ELDORADO

State

Zip

62930

County

SALINE

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/05/2020