DEREK SEAN BUMGARNER MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****23

License Status

NOT RENEWED

Business

Title

First Name

DEREK

Middle

SEAN

Last Name

BUMGARNER

Business Name

DEREK SEAN BUMGARNER MD

Original Issue Date

08/17/2015

Effective Date

04/25/2017

Expiration Date

09/30/2020

City

MONTGOMERY

State

Zip

60538

County

KENDALL

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/14/2021