ELDON MCKENZIE SAMUEL MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****89

License Status

NOT RENEWED

Business

First Name

ELDON

Middle

MCKENZIE

Last Name

SAMUEL

Suffix

Business Name

ELDON MCKENZIE SAMUEL MD

Original Issue Date

11/18/2010

Effective Date

11/18/2010

Expiration Date

07/31/2011

City

KEWANEE

State

Zip

61443

County

HENRY

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/05/2020