DAVID M COUNTRYMAN 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

Title

First Name

DAVID

Middle

Last Name

COUNTRYMAN

Business Name

DAVID M COUNTRYMAN MD

Original Issue Date

11/10/2005

Effective Date

05/10/2010

Expiration Date

07/31/2011

City

ZION

State

Zip

60099

County

LAKE

Controlled Substance Schedule

II III IV

Ever Disciplined

LastModifiedDate

04/05/2020