KIMBERLY E BROCKENBROUGH Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****04

License Status

NOT RENEWED

Business

First Name

KIMBERLY

Middle

Last Name

BROCKENBROUGH

Business Name

KIMBERLY E BROCKENBROUGH

Original Issue Date

06/23/2003

Effective Date

06/12/2014

Expiration Date

07/31/2017

City

URBANA

State

Zip

61801

County

CHAMPAIGN

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/01/2017