LEO W SULLIVAN II MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****30

License Status

ACTIVE

Business

First Name

LEO W

Last Name

SULLIVAN II

Suffix

Business Name

LEO W SULLIVAN II MD

Original Issue Date

05/22/1984

Effective Date

05/18/2023

Expiration Date

07/31/2026

City

O FALLON

State

Zip

62269

County

SAINT CLAIR

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

05/18/2023