BRADLEY D FOURAKER MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****88

License Status

NOT RENEWED

Business

First Name

BRADLEY D

Last Name

FOURAKER

Suffix

Business Name

BRADLEY D FOURAKER MD

Original Issue Date

04/04/1990

Effective Date

04/04/1990

Expiration Date

07/31/1993

City

ST LOUIS

State

Zip

63110

County

MISSOURI

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

09/26/2006