DAVID TICE ELLIS MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****33

License Status

NOT RENEWED

Business

First Name

DAVID TICE

Last Name

ELLIS

Suffix

Business Name

DAVID TICE ELLIS MD

Original Issue Date

01/01/1997

Expiration Date

07/31/2008

City

ROCKFORD

State

Zip

61101

County

WINNEBAGO

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/06/2008