TYLER JORDAN FULKS MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****81

License Status

ACTIVE

Business

Title

First Name

TYLER

Middle

JORDAN

Last Name

FULKS

Business Name

TYLER JORDAN FULKS MD

Original Issue Date

08/05/2020

Effective Date

05/05/2023

Expiration Date

07/31/2026

City

SPRINGFIELD

State

Zip

62794

County

SANGAMON

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

05/05/2023