DAMIEN L RICKLIS MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****79

License Status

NOT RENEWED

Business

Title

First Name

DAMIEN

Middle

Last Name

RICKLIS

Business Name

DAMIEN L RICKLIS MD

Original Issue Date

05/11/2011

Effective Date

05/11/2011

Expiration Date

07/31/2014

City

CARBONDALE

State

Zip

62901

County

JACKSON

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/17/2014