DEREK DOUGLAS MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****93

License Status

NOT RENEWED

Business

Title

First Name

DEREK

Last Name

DOUGLAS

Business Name

DEREK DOUGLAS MD

Original Issue Date

05/05/2021

Effective Date

05/05/2021

Expiration Date

07/31/2023

City

MARYVILLE

State

Zip

62062

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/30/2023