SUSAN M FOWELL MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****59

License Status

ACTIVE

Business

First Name

SUSAN M

Last Name

FOWELL

Suffix

Business Name

SUSAN M FOWELL MD

Original Issue Date

02/18/1987

Effective Date

06/09/2023

Expiration Date

07/31/2026

City

ROCKFORD

State

Zip

61107

County

WINNEBAGO

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

06/09/2023