EDWARD P SOUTHERN MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****70

License Status

NOT RENEWED

Business

First Name

EDWARD P

Last Name

SOUTHERN

Suffix

Business Name

EDWARD P SOUTHERN MD

Original Issue Date

06/21/1995

Effective Date

06/21/1995

Expiration Date

07/31/1996

City

CHICAGO

State

Zip

60612

County

COOK

Controlled Substance Schedule

Ever Disciplined

LastModifiedDate

09/26/2006