KELLY M FARROLL Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****83

License Status

NOT RENEWED

Business

First Name

KELLY M

Last Name

FARROLL

Business Name

KELLY M FARROLL

Original Issue Date

05/19/1997

Effective Date

05/19/1997

Expiration Date

07/31/1999

City

COLLINSVILLE

State

Zip

62234

County

MADISON

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/05/2020