GRANT ALLEN BULLOCK DO Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****39

License Status

ACTIVE

Business

Title

First Name

GRANT

Middle

ALLEN

Last Name

BULLOCK

Business Name

GRANT ALLEN BULLOCK DO

Original Issue Date

08/13/2024

Effective Date

08/13/2024

Expiration Date

07/31/2026

City

LOCKPORT

State

Zip

60441

County

WILL

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

08/13/2024