ROBERT G SLACK MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****68

License Status

NOT RENEWED

Business

First Name

ROBERT G

Last Name

SLACK

Suffix

Business Name

ROBERT G SLACK MD

Original Issue Date

12/20/1989

Effective Date

12/20/1989

Expiration Date

07/31/2008

City

CHERRY VALLEY

State

Zip

61016

County

WINNEBAGO

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/06/2008