CAMILLA JUNE FREDERICK MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****71

License Status

NOT RENEWED

Business

First Name

CAMILLA JUNE

Last Name

FREDERICK

Suffix

Business Name

CAMILLA JUNE FREDERICK MD

Original Issue Date

07/15/1999

Effective Date

07/15/1999

Expiration Date

07/31/2005

City

MILAN

State

Zip

61264

County

ROCK ISLAND

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/05/2020