THERESA DIANE MADDOX MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****91

License Status

NOT RENEWED

Business

First Name

THERESA

Middle

DIANE

Last Name

MADDOX

Suffix

Business Name

THERESA DIANE MADDOX MD

Original Issue Date

06/11/2009

Effective Date

04/15/2013

Expiration Date

07/31/2014

City

ROCKFORD

State

Zip

61104

County

WINNEBAGO

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/17/2014