MADISON SAMPLE JR Medical Doctor License verification

Business Entity

INOPERATIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****77

License Status

INOPERATIVE

Business

First Name

MADISON

Last Name

SAMPLE JR

Business Name

MADISON SAMPLE JR

Original Issue Date

06/12/1996

Effective Date

09/12/2023

Expiration Date

07/31/2026

City

JOLIET

State

Zip

60435

County

WILL

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

09/12/2023