BO T HEADLAM Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****92

License Status

NOT RENEWED

Business

First Name

Middle

Last Name

HEADLAM

Business Name

BO T HEADLAM

Original Issue Date

03/20/2006

Effective Date

07/24/2014

Expiration Date

07/31/2017

City

PORTSMOUTH

State

Zip

45662

County

OHIO

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/01/2017