BRIAN MATTHEW FULLER MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****60

License Status

ACTIVE

Business

Title

First Name

BRIAN

Middle

MATTHEW

Last Name

FULLER

Business Name

BRIAN MATTHEW FULLER MD

Original Issue Date

05/10/2019

Effective Date

06/21/2023

Expiration Date

07/31/2026

City

SHILOH

State

Zip

62269

County

SAINT CLAIR

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

06/21/2023