CHARLES RICHARD WILSON MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****52

License Status

NOT RENEWED

Business

Title

First Name

CHARLES

Middle

RICHARD

Last Name

WILSON

Business Name

CHARLES RICHARD WILSON MD

Original Issue Date

06/28/2019

Effective Date

06/28/2019

Expiration Date

09/30/2020

City

GREAT FALLS

State

Zip

59404

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/14/2021