JEFFREY S POULTER MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****62

License Status

ACTIVE

Business

First Name

JEFFREY S

Last Name

POULTER

Suffix

Business Name

JEFFREY S POULTER MD

Original Issue Date

05/15/1992

Effective Date

06/03/2023

Expiration Date

07/31/2026

City

BLOOMINGTON

State

Zip

61701

County

MCLEAN

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

06/03/2023