KENNETH D PHILLIPS JR 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

KENNETH D

Last Name

PHILLIPS JR

Suffix

Business Name

KENNETH D PHILLIPS JR MD

Original Issue Date

11/02/1993

Effective Date

11/02/1993

Expiration Date

07/31/1996

City

PEORIA

State

Zip

61603

County

PEORIA

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/05/2020