NATASHA RAE SHALLOW MD Medical Doctor License verification

NATASHA RAE SHALLOW MD

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****30

License Status

NOT RENEWED

Business

Title

First Name

NATASHA

Middle

RAE

Last Name

SHALLOW

Business Name

NATASHA RAE SHALLOW MD

Original Issue Date

12/30/2015

Effective Date

12/30/2015

Expiration Date

07/31/2017

City

BROOKFIELD

State

Zip

53005

County

WISCONSIN

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/01/2017

Case Number

2017005318

Action

Temporary Suspension

Discipline Start Date

06/07/2017

Discipline End Date

08/21/2017

Discipline Reason

Temporary Suspension for Sister State Discipline.