BRIAN MATTHEW FULLER MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****62

License Status

NOT RENEWED

Business

Title

First Name

BRIAN

Middle

MATTHEW

Last Name

FULLER

Business Name

BRIAN MATTHEW FULLER MD

Original Issue Date

05/10/2019

Effective Date

05/10/2019

Expiration Date

09/30/2020

City

ALTON

State

Zip

62002

County

MADISON

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/14/2021