DOUGLAS R ELLIS MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****51

License Status

ACTIVE

Business

First Name

DOUGLAS R

Last Name

ELLIS

Suffix

Business Name

DOUGLAS R ELLIS MD

Original Issue Date

12/17/1990

Effective Date

07/08/2023

Expiration Date

07/31/2026

City

LATHAM

State

Zip

62543

County

PIATT

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

07/08/2023