GARY EUGENE STANFORD 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

GARY EUGENE

Last Name

STANFORD

Suffix

Business Name

GARY EUGENE STANFORD MD

Original Issue Date

01/01/1997

Expiration Date

07/31/1987

City

NEWARK

State

Zip

60541

County

GRUNDY

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

09/26/2006