PANNA R SHAH MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****75

License Status

NOT RENEWED

Business

First Name

PANNA R

Last Name

SHAH

Suffix

Business Name

PANNA R SHAH MD

Original Issue Date

03/30/1995

Effective Date

03/30/1995

Expiration Date

07/31/2002

City

ROCKFORD

State

Zip

61103

County

WINNEBAGO

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/05/2020