HETAL R DAVE 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

First Name

HETAL

Middle

Last Name

DAVE

Suffix

Business Name

HETAL R DAVE MD

Original Issue Date

08/13/2003

Effective Date

08/13/2003

Expiration Date

07/31/2008

City

TAYLORVILLE

State

Zip

62568

County

CHRISTIAN

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/12/2017