PHILLIP K FULKERSON MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****31

License Status

CANCELLED

Business

First Name

PHILLIP K

Last Name

FULKERSON

Suffix

Business Name

PHILLIP K FULKERSON MD

Original Issue Date

11/14/1996

Effective Date

11/14/1996

Expiration Date

07/31/2008

City

ROSCOE

State

Zip

61073

County

WINNEBAGO

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

09/26/2006