JULIE MARIE FULTZ MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125060358

License Status

CANCELLED

Business

Title

First Name

JULIE

Middle

MARIE

Last Name

FULTZ

Business Name

JULIE MARIE FULTZ MD

Original Issue Date

06/26/2011

Effective Date

06/26/2011

Expiration Date

06/25/2014

City

SPRINGFIELD

State

Zip

62701

County

SANGAMON

Specialty/Qualifier

Emergency Medicine

Ever Disciplined

LastModifiedDate

06/17/2011