EBENEZER BERKO Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****54

License Status

CANCELLED

Business

First Name

EBENEZER

Last Name

BERKO

Business Name

EBENEZER BERKO

Original Issue Date

11/07/2002

Effective Date

05/30/2008

Expiration Date

07/31/2011

City

ROCKFORD

State

Zip

61108

County

WINNEBAGO

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/07/2011