ETHAN MICHAEL PHILPOTT Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****54

License Status

NOT RENEWED

Business

First Name

ETHAN

Middle

MICHAEL

Last Name

PHILPOTT

Business Name

ETHAN MICHAEL PHILPOTT

Original Issue Date

01/31/2011

Effective Date

06/06/2014

Expiration Date

07/31/2017

City

QUINCY

State

Zip

62301

County

ADAMS

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/01/2017