FREDERICK PAUL O'BRIEN III Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****16

License Status

NOT RENEWED

Business

First Name

FREDERICK

Middle

PAUL

Last Name

O'BRIEN III

Business Name

FREDERICK PAUL O'BRIEN III

Original Issue Date

02/06/2019

Effective Date

02/06/2019

Expiration Date

09/30/2020

City

ROCKFORD

State

Zip

61103

County

WINNEBAGO

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/14/2021