SUSAN R PROVOW MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****93

License Status

NOT RENEWED

Business

First Name

SUSAN R

Last Name

PROVOW

Suffix

Business Name

SUSAN R PROVOW MD

Original Issue Date

07/22/1988

Effective Date

06/05/2014

Expiration Date

07/31/2017

City

ROCK FALLS

State

Zip

61071

County

WHITESIDE

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/01/2017