ADAM KIRK DERRICKSON MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****03

License Status

NOT RENEWED

Business

Title

First Name

ADAM

Middle

KIRK

Last Name

DERRICKSON

Business Name

ADAM KIRK DERRICKSON MD

Original Issue Date

06/03/2009

Effective Date

04/25/2011

Expiration Date

07/31/2014

City

OFALLON

State

Zip

62269

County

SAINT CLAIR

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/08/2014