ALEX EDWARD FULTZ MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125073898

License Status

CANCELLED

Business

Title

First Name

ALEX

Middle

EDWARD

Last Name

FULTZ

Business Name

ALEX EDWARD FULTZ MD

Original Issue Date

06/22/2019

Effective Date

06/22/2019

Expiration Date

06/21/2022

City

MAYWOOD

State

Zip

60153

County

COOK

Specialty/Qualifier

Internal Medicine

Ever Disciplined

LastModifiedDate

05/01/2019