JEFFREY S POULTER MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****40

License Status

NOT RENEWED

Business

First Name

JEFFREY S

Last Name

POULTER

Suffix

Business Name

JEFFREY S POULTER MD

Original Issue Date

03/17/2009

Effective Date

07/24/2017

Expiration Date

09/30/2020

City

PEORIA

State

Zip

61614

County

PEORIA

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/14/2021