CHAD RYAN FOWLER MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****63

License Status

NOT RENEWED

Business

First Name

CHAD

Middle

RYAN

Last Name

FOWLER

Suffix

Business Name

CHAD RYAN FOWLER MD

Original Issue Date

05/12/2005

Effective Date

07/07/2008

Expiration Date

07/31/2011

City

ALTON

State

Zip

62002

County

MADISON

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/10/2011