MEREDITH PRICE PROVOST MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****08

License Status

ACTIVE

Business

Title

First Name

MEREDITH

Middle

PRICE

Last Name

PROVOST

Business Name

MEREDITH PRICE PROVOST MD

Original Issue Date

07/25/2016

Effective Date

07/15/2023

Expiration Date

07/31/2026

City

INDIANAPOLIS

State

Zip

46280

County

CHAMPAIGN

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

07/15/2023