TED W FAULL MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****21

License Status

NOT RENEWED

Business

First Name

TED W

Last Name

FAULL

Suffix

Business Name

TED W FAULL MD

Original Issue Date

08/30/1993

Effective Date

04/17/2008

Expiration Date

07/31/2011

City

ROCKFORD

State

Zip

61109

County

WINNEBAGO

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/10/2011