LAURENCE EDWARD DOMINO MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****48

License Status

CANCELLED

Business

First Name

LAURENCE EDWARD

Last Name

DOMINO

Suffix

Business Name

LAURENCE EDWARD DOMINO MD

Original Issue Date

11/21/1986

Effective Date

11/21/1986

Expiration Date

07/31/1990

City

SPRINGFIELD

State

Zip

62708

County

SANGAMON

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

09/26/2006