GEORGIE A EAPEN Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****45

License Status

NOT RENEWED

Business

First Name

GEORGIE A

Last Name

EAPEN

Business Name

GEORGIE A EAPEN

Original Issue Date

08/06/1996

Effective Date

08/06/1996

Expiration Date

07/31/1999

City

SPRINGFIELD

State

Zip

62781

County

SANGAMON

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

09/26/2006