GRANVILLE JOSEPH PHILLIPS MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****79

License Status

CANCELLED

Business

First Name

GRANVILLE

Middle

JOSEPH

Last Name

PHILLIPS

Suffix

Business Name

GRANVILLE JOSEPH PHILLIPS MD

Original Issue Date

10/21/2002

Effective Date

10/21/2002

Expiration Date

07/31/2008

City

CHESTER

State

Zip

62233

County

RANDOLPH

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/17/2008