GLENN EVAN DAVISON MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****76

License Status

NOT RENEWED

Business

First Name

GLENN EVAN

Last Name

DAVISON

Suffix

Business Name

GLENN EVAN DAVISON MD

Original Issue Date

06/26/1996

Effective Date

06/26/1996

Expiration Date

07/31/1999

City

STAUNTON

State

Zip

62088

County

MACOUPIN

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/09/2006