FRED LEE CROCKETT JR MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****99

License Status

NOT RENEWED

Business

First Name

FRED LEE

Last Name

CROCKETT JR

Suffix

Business Name

FRED LEE CROCKETT JR MD

Original Issue Date

01/01/1997

Expiration Date

07/31/1996

City

DANVILLE

State

Zip

61832

County

VERMILION

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

09/26/2006