KELLY M FARROLL Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****82

License Status

ACTIVE

Business

First Name

KELLY M

Last Name

FARROLL

Business Name

KELLY M FARROLL

Original Issue Date

12/18/1996

Effective Date

04/23/2023

Expiration Date

07/31/2026

City

EDWARDSVILLE

State

Zip

62026

County

MADISON

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/23/2023