MARK STEVEN SHOCKLEY MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****30

License Status

CANCELLED

Business

First Name

MARK

Middle

STEVEN

Last Name

SHOCKLEY

Suffix

Business Name

MARK STEVEN SHOCKLEY MD

Original Issue Date

05/16/2001

Effective Date

05/16/2001

Expiration Date

07/31/2002

City

FREEPORT

State

Zip

61032

County

STEPHENSON

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/09/2006