FALAN K MOUTON MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****80

License Status

NOT RENEWED

Business

Title

First Name

FALAN

Middle

Last Name

MOUTON

Business Name

FALAN K MOUTON MD

Original Issue Date

08/03/2015

Effective Date

04/11/2017

Expiration Date

09/30/2020

City

PEORIA

State

Zip

61636

County

PEORIA

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/14/2021