DAN FENTON MILLARD MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****89

License Status

NOT RENEWED

Business

First Name

DAN

Middle

FENTON

Last Name

MILLARD

Suffix

Business Name

DAN FENTON MILLARD MD

Original Issue Date

11/14/2006

Effective Date

10/29/2014

Expiration Date

07/31/2017

City

PEORIA

State

Zip

61615

County

PEORIA

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/01/2017