D THANE CODY 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

Middle

THANE

Last Name

CODY

Suffix

Business Name

D THANE CODY MD

Original Issue Date

10/07/2005

Effective Date

08/04/2008

Expiration Date

07/31/2011

City

GENESEO

State

Zip

61254

County

HENRY

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/05/2020