BRADLEY V DAVITT MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****92

License Status

CANCELLED

Business

First Name

BRADLEY V

Last Name

DAVITT

Suffix

Business Name

BRADLEY V DAVITT MD

Original Issue Date

06/16/1997

Effective Date

06/16/1997

Expiration Date

07/31/2005

City

COLLINSVILLE

State

Zip

62234

County

MADISON

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/09/2006