DERRICK ALWYN FOX MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****81

License Status

NOT RENEWED

Business

Title

First Name

DERRICK

Middle

ALWYN

Last Name

FOX

Business Name

DERRICK ALWYN FOX MD

Original Issue Date

07/01/2019

Effective Date

08/25/2020

Expiration Date

07/31/2023

City

BLOOMINGTON

State

Zip

61705

County

MCLEAN

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/30/2023