RUSSELL FREDERIC LA BEAU JR MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****56

License Status

NOT RENEWED

Business

First Name

RUSSELL FREDERIC

Last Name

LA BEAU JR

Suffix

Business Name

RUSSELL FREDERIC LA BEAU JR MD

Original Issue Date

03/15/1995

Effective Date

03/15/1995

Expiration Date

07/31/1999

City

MOLINE

State

Zip

61265

County

ROCK ISLAND

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

09/26/2006