TIMOTHY A PUCKETT MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036093684

License Status

NOT RENEWED

Business

First Name

TIMOTHY A

Last Name

PUCKETT

Suffix

Business Name

TIMOTHY A PUCKETT MD

Original Issue Date

07/19/1996

Effective Date

07/19/1996

Expiration Date

07/31/1999

City

SPRINGFIELD

State

Zip

62794

County

SANGAMON

Ever Disciplined

LastModifiedDate

09/20/2006