MARK FULLER SEWELL MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****67

License Status

CANCELLED

Business

Title

First Name

MARK

Middle

FULLER

Last Name

SEWELL

Business Name

MARK FULLER SEWELL MD

Original Issue Date

04/12/2012

Effective Date

04/12/2012

Expiration Date

07/31/2014

City

ROCKFORD

State

Zip

61103

County

WINNEBAGO

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/08/2014