SHAWN MARK JOHNSON MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****88

License Status

NOT RENEWED

Business

Title

First Name

SHAWN

Middle

MARK

Last Name

JOHNSON

Business Name

SHAWN MARK JOHNSON MD

Original Issue Date

06/11/2010

Effective Date

06/28/2011

Expiration Date

07/31/2014

City

FORT WAYNE

State

Zip

46804

County

INDIANA

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/17/2014