CHARLES EDWARD MONTGOMERY MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****59

License Status

NOT RENEWED

Business

First Name

CHARLES EDWARD

Last Name

MONTGOMERY

Suffix

Business Name

CHARLES EDWARD MONTGOMERY MD

Original Issue Date

01/01/1997

Effective Date

07/28/2008

Expiration Date

07/31/2011

City

PEORIA

State

Zip

61614

County

PEORIA

Controlled Substance Schedule

II III IV

Ever Disciplined

LastModifiedDate

11/10/2011