AMY J EWEN Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****31

License Status

NOT RENEWED

Business

First Name

AMY

Middle

Last Name

EWEN

Business Name

AMY J EWEN

Original Issue Date

03/13/2003

Effective Date

03/13/2003

Expiration Date

07/31/2005

City

SPRINGFIELD

State

Zip

62702

County

SANGAMON

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/09/2006