RICHARD JAMES STORK MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****39

License Status

NOT RENEWED

Business

Title

First Name

RICHARD

Middle

JAMES

Last Name

STORK

Business Name

RICHARD JAMES STORK MD

Original Issue Date

09/19/2011

Effective Date

09/19/2011

Expiration Date

07/31/2014

City

EDWARDSVILLE

State

Zip

62025

County

MADISON

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/17/2014