GANNON T DUDLAR MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****69

License Status

NOT RENEWED

Business

First Name

GANNON

Middle

Last Name

DUDLAR

Suffix

Business Name

GANNON T DUDLAR MD

Original Issue Date

08/28/2001

Effective Date

06/26/2017

Expiration Date

09/30/2020

City

CHICAGO

State

Zip

60610

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/14/2021