JAMES E PROVO MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****99

License Status

NOT RENEWED

Business

First Name

JAMES E

Last Name

PROVO

Suffix

Business Name

JAMES E PROVO MD

Original Issue Date

09/16/1992

Effective Date

09/16/1992

Expiration Date

07/31/2002

City

AURORA

State

Zip

60505

County

KANE

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/09/2006