GARY DEAN SHACKELFORD MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036043983

License Status

NOT RENEWED

Business

First Name

GARY DEAN

Last Name

SHACKELFORD

Suffix

Business Name

GARY DEAN SHACKELFORD MD

Original Issue Date

01/19/1971

Effective Date

01/19/1971

City

ST LOUIS

State

Zip

63117

County

MISSOURI

Ever Disciplined

LastModifiedDate

09/20/2006