MARK R PHILLIPS MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****01

License Status

NOT RENEWED

Business

First Name

MARK R

Last Name

PHILLIPS

Suffix

Business Name

MARK R PHILLIPS MD

Original Issue Date

11/16/1983

Effective Date

04/20/2017

Expiration Date

09/30/2020

City

PEORIA

State

Zip

61605

County

PEORIA

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/14/2021