TERRANCE RUDOLPH GRANT MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****43

License Status

ACTIVE

Business

First Name

TERRANCE

Middle

RUDOLPH

Last Name

GRANT

Suffix

Business Name

TERRANCE RUDOLPH GRANT MD

Original Issue Date

05/03/2017

Effective Date

07/30/2023

Expiration Date

07/31/2026

City

ROCKFORD

State

Zip

61103

County

WINNEBAGO

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

07/30/2023