TIMOTHY A PUCKETT MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****19

License Status

NOT RENEWED

Business

First Name

TIMOTHY A

Last Name

PUCKETT

Suffix

Business Name

TIMOTHY A PUCKETT MD

Original Issue Date

07/22/1996

Effective Date

07/22/1996

Expiration Date

07/31/1999

City

SPRINGFIELD

State

Zip

62794

County

SANGAMON

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

09/26/2006