EDWARD L P SHACKLEFORD DO Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****70

License Status

ACTIVE

Business

First Name

EDWARD L P

Last Name

SHACKLEFORD

Suffix

Business Name

EDWARD L P SHACKLEFORD DO

Original Issue Date

07/17/1996

Effective Date

07/08/2023

Expiration Date

07/31/2026

City

GURNEE

State

Zip

60031

County

LAKE

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

07/08/2023