PENELOPE ALEXANDRIA SANDIFORD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****40

License Status

ACTIVE

Business

First Name

PENELOPE

Middle

ALEXANDRIA

Last Name

SANDIFORD

Business Name

PENELOPE ALEXANDRIA SANDIFORD

Original Issue Date

05/06/2009

Effective Date

06/22/2023

Expiration Date

07/31/2026

City

PEORIA

State

Zip

61637

County

PEORIA

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

06/22/2023