SAMUEL DALTON CAPOUCH MD 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

SAMUEL

Middle

DALTON

Last Name

CAPOUCH

Business Name

SAMUEL DALTON CAPOUCH MD

Original Issue Date

06/07/2023

Effective Date

06/07/2023

Expiration Date

07/31/2026

City

SPRINGFIELD

State

Zip

62712

County

SANGAMON

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

06/07/2023