PHILIP GREGORY FIELDS MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****18

License Status

CANCELLED

Business

First Name

PHILIP

Middle

GREGORY

Last Name

FIELDS

Suffix

Business Name

PHILIP GREGORY FIELDS MD

Original Issue Date

03/24/2005

Effective Date

03/24/2005

Expiration Date

07/31/2008

City

ALTON

State

Zip

62002

County

MADISON

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/17/2008