MARTIN J BUCKINGHAM MD 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

Title

First Name

MARTIN

Middle

Last Name

BUCKINGHAM

Business Name

MARTIN J BUCKINGHAM MD

Original Issue Date

01/03/1990

Effective Date

04/16/2014

Expiration Date

07/31/2017

City

ROCKFORD

State

Zip

61103

County

WINNEBAGO

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/01/2017