HEATHER NELL GILLUM MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****36

License Status

NOT RENEWED

Business

First Name

HEATHER

Middle

NELL

Last Name

GILLUM

Suffix

Business Name

HEATHER NELL GILLUM MD

Original Issue Date

08/29/2003

Effective Date

08/29/2003

Expiration Date

07/31/2008

City

CHESTER

State

Zip

62233

County

RANDOLPH

Controlled Substance Schedule

III IV V

Ever Disciplined

LastModifiedDate

11/06/2008