JEREMY DWAIN GILLIAM MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****16

License Status

NOT RENEWED

Business

Title

First Name

JEREMY

Middle

DWAIN

Last Name

GILLIAM

Business Name

JEREMY DWAIN GILLIAM MD

Original Issue Date

04/21/2014

Effective Date

04/21/2014

Expiration Date

07/31/2017

City

FORT WAYNE

State

Zip

46804

County

INDIANA

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/05/2020