PRECIOUS MENA SADE GADDIS MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****40

License Status

ACTIVE

Business

Title

First Name

PRECIOUS

Middle

MENA SADE

Last Name

GADDIS

Business Name

PRECIOUS MENA SADE GADDIS MD

Original Issue Date

07/08/2020

Effective Date

07/25/2023

Expiration Date

07/31/2026

City

ROCKFORD

State

Zip

61107

County

WINNEBAGO

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

07/25/2023