KEENAN WAYNE TAYLOR MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****66

License Status

NOT RENEWED

Business

First Name

KEENAN

Middle

WAYNE

Last Name

TAYLOR

Suffix

Business Name

KEENAN WAYNE TAYLOR MD

Original Issue Date

09/18/2019

Effective Date

09/18/2019

Expiration Date

09/30/2020

City

ROCKFORD

State

Zip

61104

County

WINNEBAGO

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/14/2021