GRACE E LOGAN 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

Title

First Name

GRACE

Middle

Last Name

LOGAN

Business Name

GRACE E LOGAN MD

Original Issue Date

03/15/2019

Effective Date

03/15/2019

Expiration Date

09/30/2020

City

SHILOH

State

Zip

62269

County

SAINT CLAIR

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/14/2021