DERRICK ALAN MONTGOMERY MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036114081

License Status

NOT RENEWED

Business

First Name

DERRICK

Middle

ALAN

Last Name

MONTGOMERY

Suffix

Business Name

DERRICK ALAN MONTGOMERY MD

Original Issue Date

06/30/2005

Effective Date

08/01/2014

Expiration Date

07/31/2017

City

DANVILLE

State

Zip

61832

County

VERMILION

Ever Disciplined

LastModifiedDate

11/01/2017