JOHN PHILLIPPE BROADNAX Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****68

License Status

NOT RENEWED

Business

First Name

JOHN

Middle

PHILLIPPE

Last Name

BROADNAX

Business Name

JOHN PHILLIPPE BROADNAX

Original Issue Date

08/03/2009

Effective Date

04/17/2017

Expiration Date

09/30/2020

City

DECATUR

State

Zip

62526

County

LAKE

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/14/2021