MARY DENISE MOORE MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****43

License Status

NOT RENEWED

Business

First Name

MARY

Middle

DENISE

Last Name

MOORE

Suffix

Business Name

MARY DENISE MOORE MD

Original Issue Date

07/25/2000

Effective Date

07/25/2000

Expiration Date

07/31/2005

City

ROCKFORD

State

Zip

61103

County

WINNEBAGO

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/09/2006