MARK EDWARD DIEBEL 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

Title

First Name

MARK

Middle

EDWARD

Last Name

DIEBEL

Business Name

MARK EDWARD DIEBEL MD

Original Issue Date

07/24/2018

Effective Date

07/24/2018

Expiration Date

09/30/2020

City

ROCKFORD

State

Zip

61104

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/14/2021