NEIL W FREDERICKSON MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****70

License Status

NOT RENEWED

Business

First Name

NEIL W

Last Name

FREDERICKSON

Suffix

Business Name

NEIL W FREDERICKSON MD

Original Issue Date

09/26/1988

Effective Date

09/28/2020

Expiration Date

07/31/2023

City

MARYVILLE

State

Zip

62062

County

MADISON

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/30/2023