THOMAS JON POULTON MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****29

License Status

NOT RENEWED

Business

Title

First Name

THOMAS

Middle

JON

Last Name

POULTON

Business Name

THOMAS JON POULTON MD

Original Issue Date

03/12/2015

Effective Date

03/12/2015

Expiration Date

07/31/2017

City

PEORIA

State

Zip

61637

County

PEORIA

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/01/2017