CHARLES WILLIAM LONGWELL III MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****72

License Status

NOT RENEWED

Business

Title

First Name

CHARLES

Middle

WILLIAM

Last Name

LONGWELL

Suffix

III

Business Name

CHARLES WILLIAM LONGWELL III MD

Original Issue Date

06/10/2010

Effective Date

06/10/2010

Expiration Date

07/31/2011

City

SPRINGFIELD

State

Zip

62781

County

SANGAMON

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/10/2011