CASSIDY RAY LONG DO Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****92

License Status

NOT RENEWED

Business

Title

First Name

CASSIDY

Middle

RAY

Last Name

LONG

Business Name

CASSIDY RAY LONG DO

Original Issue Date

06/02/2015

Effective Date

07/24/2017

Expiration Date

09/30/2020

City

GALESBURG

State

Zip

61401

County

KNOX

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/14/2021