BRIAN EDWARD SULLIVAN MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****74

License Status

ACTIVE

Business

First Name

BRIAN

Middle

EDWARD

Last Name

SULLIVAN

Suffix

Business Name

BRIAN EDWARD SULLIVAN MD

Original Issue Date

01/12/2007

Effective Date

07/03/2023

Expiration Date

07/31/2026

City

GALENA

State

Zip

61036

County

JO DAVIESS

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

07/03/2023