PHILLIP K FULKERSON MD Medical Doctor License verification

Business Entity

INACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036094314

License Status

INACTIVE

Business

First Name

PHILLIP K

Last Name

FULKERSON

Suffix

Business Name

PHILLIP K FULKERSON MD

Original Issue Date

10/04/1996

Effective Date

07/31/2006

Expiration Date

07/31/2008

City

ROSCOE

State

Zip

61073

County

WINNEBAGO

Ever Disciplined

LastModifiedDate

09/20/2006