TRAVIS L BULLOCK MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****38

License Status

ACTIVE

Business

First Name

TRAVIS

Middle

Last Name

BULLOCK

Suffix

Business Name

TRAVIS L BULLOCK MD

Original Issue Date

10/10/2007

Effective Date

06/09/2023

Expiration Date

07/31/2026

City

MARYVILLE

State

Zip

62062

County

MADISON

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

06/09/2023