THOMAS EDWARD GREEN DO Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****96

License Status

CANCELLED

Business

First Name

THOMAS

Middle

EDWARD

Last Name

GREEN

Suffix

Business Name

THOMAS EDWARD GREEN DO

Original Issue Date

06/19/2008

Effective Date

06/13/2012

Expiration Date

07/31/2014

City

PEORIA

State

Zip

61637

County

PEORIA

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/08/2014