NATHAN PAUL FREDRICK DO Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****74

License Status

ACTIVE

Business

Title

First Name

NATHAN

Middle

PAUL

Last Name

FREDRICK

Business Name

NATHAN PAUL FREDRICK DO

Original Issue Date

10/01/2008

Effective Date

08/24/2023

Expiration Date

07/31/2026

City

PEORIA

State

Zip

61636

County

PEORIA

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

08/24/2023