DANE J NICHOLS MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****34

License Status

NOT RENEWED

Business

First Name

DANE J

Last Name

NICHOLS

Suffix

Business Name

DANE J NICHOLS MD

Original Issue Date

01/12/1993

Effective Date

01/12/1993

Expiration Date

07/31/1999

City

PEORIA

State

Zip

61656

County

PEORIA

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

09/26/2006