DAVID WILLIAM MACK MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****74

License Status

NOT RENEWED

Business

First Name

DAVID

Middle

WILLIAM

Last Name

MACK

Suffix

Business Name

DAVID WILLIAM MACK MD

Original Issue Date

11/27/2001

Effective Date

04/17/2008

Expiration Date

07/31/2011

City

SPRINGFIELD

State

Zip

62704

County

SANGAMON

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/12/2017