WILLIAM A P SUPAN MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****88

License Status

NOT RENEWED

Business

First Name

WILLIAM

Middle

A P

Last Name

SUPAN

Suffix

Business Name

WILLIAM A P SUPAN MD

Original Issue Date

01/01/1997

Effective Date

05/13/2014

Expiration Date

07/31/2017

City

BLOOMINGTON

State

Zip

61701

County

MCLEAN

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/01/2017