LEROY PHILLIP BACH MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****35

License Status

NOT RENEWED

Business

First Name

LEROY PHILLIP

Last Name

BACH

Suffix

Business Name

LEROY PHILLIP BACH MD

Original Issue Date

01/01/1997

Effective Date

07/14/2011

Expiration Date

07/31/2014

City

ROCKFORD

State

Zip

61108

County

WINNEBAGO

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/17/2014