KELLY ANNE SUPPLE MD - Medical Doctor License in Pennsylvania | # 33*****15

KELLY ANNE SUPPLE MD

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****15

License Status

NOT RENEWED

Business

N

First Name

KELLY

Middle

ANNE

Last Name

SUPPLE

Suffix

MD

Business Name

KELLY ANNE SUPPLE MD

Original Issue Date

10/14/1998

Effective Date

10/26/2011

Expiration Date

07/31/2014

State

PA

Controlled Substance Schedule

II III IV V

Ever Disciplined

N

LastModifiedDate

11/17/2014