BRADLEY T DEWALL MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****44

License Status

NOT RENEWED

Business

First Name

BRADLEY T

Last Name

DEWALL

Suffix

Business Name

BRADLEY T DEWALL MD

Original Issue Date

10/06/2011

Effective Date

07/24/2017

Expiration Date

09/30/2020

City

MOLINE

State

Zip

61265

County

ROCK ISLAND

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/14/2021