GARY BRETT WESTERN MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****67

License Status

NOT RENEWED

Business

First Name

GARY

Middle

BRETT

Last Name

WESTERN

Suffix

Business Name

GARY BRETT WESTERN MD

Original Issue Date

04/11/2002

Effective Date

04/11/2002

Expiration Date

07/31/2005

City

SPRINGFIELD

State

Zip

62703

County

SANGAMON

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/05/2020