ANDREA M HUMPHREY MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****43

License Status

NOT RENEWED

Business

First Name

ANDREA

Middle

Last Name

HUMPHREY

Suffix

Business Name

ANDREA M HUMPHREY MD

Original Issue Date

10/20/2000

Effective Date

10/20/2000

Expiration Date

07/31/2002

City

SPRINGFIELD

State

Zip

62702

County

SANGAMON

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/05/2020