CODY WAYNE SULLIVAN MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****52

License Status

ACTIVE

Business

Title

First Name

CODY

Middle

WAYNE

Last Name

SULLIVAN

Business Name

CODY WAYNE SULLIVAN MD

Original Issue Date

08/16/2023

Effective Date

08/16/2023

Expiration Date

07/31/2026

City

PADUCAH

State

Zip

42003

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

08/16/2023