DOUGLAS NOBLE SULLIVANT MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****77

License Status

ACTIVE

Business

First Name

DOUGLAS NOBLE

Last Name

SULLIVANT

Suffix

Business Name

DOUGLAS NOBLE SULLIVANT MD

Original Issue Date

08/09/1995

Effective Date

05/23/2023

Expiration Date

07/31/2026

City

QUINCY

State

Zip

62301

County

ADAMS

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

05/23/2023