TYLER JORDAN FULKS MD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125068994

License Status

EXPIRED

Business

Title

First Name

TYLER

Middle

JORDAN

Last Name

FULKS

Business Name

TYLER JORDAN FULKS MD

Original Issue Date

06/26/2016

Effective Date

06/26/2016

Expiration Date

06/25/2019

City

SPRINGFIELD

State

Zip

62701

County

SANGAMON

Specialty/Qualifier

Emergency Medicine

Ever Disciplined

LastModifiedDate

10/02/2019