DOUGLAS EDWIN HENRICH MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****79

License Status

CANCELLED

Business

First Name

DOUGLAS

Middle

EDWIN

Last Name

HENRICH

Suffix

Business Name

DOUGLAS EDWIN HENRICH MD

Original Issue Date

08/21/2001

Effective Date

08/21/2001

Expiration Date

07/31/2005

City

MONMOUTH

State

Zip

61462

County

WARREN

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/09/2006