SAM MARTIN FULLER MD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125056434

License Status

EXPIRED

Business

First Name

SAM

Middle

MARTIN

Last Name

FULLER

Suffix

Business Name

SAM MARTIN FULLER MD

Original Issue Date

07/01/2012

Effective Date

07/01/2012

Expiration Date

06/30/2015

City

CHICAGO

State

Zip

60637

County

COOK

Specialty/Qualifier

Plastic Surgery

Ever Disciplined

LastModifiedDate

09/04/2015