ETHAN MARK HUCKABEE DO Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****65

License Status

ACTIVE

Business

Title

First Name

ETHAN

Middle

MARK

Last Name

HUCKABEE

Business Name

ETHAN MARK HUCKABEE DO

Original Issue Date

10/11/2022

Effective Date

06/29/2023

Expiration Date

07/31/2026

City

MOUNT VERNON

State

Zip

62864

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

06/29/2023