ADAM KIRK DERRICKSON MD Medical Doctor License verification

Business Entity

INACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036123597

License Status

INACTIVE

Business

Title

First Name

ADAM

Middle

KIRK

Last Name

DERRICKSON

Business Name

ADAM KIRK DERRICKSON MD

Original Issue Date

06/01/2009

Effective Date

04/25/2011

Expiration Date

07/31/2014

City

SPRINGBORO

State

Zip

45066

County

OHIO

Ever Disciplined

LastModifiedDate

04/08/2014