BRIAN PECK FAWCETT MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****94

License Status

NOT RENEWED

Business

Title

First Name

BRIAN

Middle

PECK

Last Name

FAWCETT

Business Name

BRIAN PECK FAWCETT MD

Original Issue Date

04/11/2011

Effective Date

04/11/2011

Expiration Date

07/31/2014

City

SPRINGFIELD

State

Zip

62711

County

SANGAMON

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/17/2014