CARL BLAINE MYERS JR MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****86

License Status

NOT RENEWED

Business

First Name

CARL

Middle

BLAINE

Last Name

MYERS

Suffix

JR MD

Business Name

CARL BLAINE MYERS JR MD

Original Issue Date

08/07/2000

Effective Date

08/07/2000

Expiration Date

07/31/2005

City

ROCKFORD

State

Zip

61108

County

WINNEBAGO

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/11/2017