SHANNON B RIDER 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

SHANNON

Middle

Last Name

RIDER

Business Name

SHANNON B RIDER

Original Issue Date

01/07/2002

Effective Date

01/07/2002

Expiration Date

07/31/2002

City

SPRINGFIELD

State

Zip

62781

County

SANGAMON

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/05/2020