MEDICAL LICENSES
04/10/2006 – Medical License - Alaska # 5778 / Active
State of Alaska
Department of Commerce,Community and Economic Development
Division of Occupational Licensing
P.O. Box 110806
Juneau, AK 99811-0806
Phone (907) 465-2534
10/08/10 – Medical License - Arkansas # E-6715 / Active
State of Arkansas
2100 Riverfront Drive
Little Rock, AR 72202
Phone (501) 296-1802
Fax (501)-603-3555
1994 – Medical License – Illinois # 036-087965 –Active
State of Illinois
Department of Professional Regulations
320 W. Washington Avenue
Springfield, IL 62786
Phone ( 217) 785-0800
10/13/11 - Medical License - Iowa # 39865
Iowa Board of Medicine
400 S.W. 8th Street, Suite C
Des Moines, IA 50309-4686
Phone ( 515) 281-5172
6/14/79 – Medical License – Louisiana # 015289 / Active
LA State Board of Medical Examiners
P.O. Box 30250
New Orleans, LA 70190-0250
Phone (504) 524-6763
08/2008 – Medical License – Missouri # 2008025535 / Active
Division of Professional Registration
P.O. Box 4
Jefferson City, MO 65102
Phone (573) 751-0098
Controlled Substance # 1301399829
10/6/10 - Medical License – North Carolina # 2010-01802 / Active
NC Medical Board
P.O. Box 20007
Raleigh, North Carolina 27619-0007
Phone (919) 326-1131
7/28/10 – Medical License – Pennsylvania # MD440814 / Active
Commonwealth of Pennsylvania
Department of State
Bureau of Professional And Occupational Affairs
P.O. Box 2649
Harrisburg, PA 17105-2649
8/26/1992 – Medical License – Tennessee # 023924 / Active
State of Tennessee
Board of Medical Examiners
287 Plus Park Blvd.
Nashville, TN 37217
Phone (615) 532-5222
Fax (615) 253-4484
4/1/2009 – Medical License – Utah # 7222868-1205 / Active
Division of Occupational And Professional Licensing
160 East 300 South
P.O. Box 1476741
Salt Lake City, Utah 84114-6741
Fax (801) 530-6511
Controlled Substance # 7222868-8905
8/1/1988 – Medical License – Virginia # 0101-042768 / Active
Commonwealth of VA
Department of Health Professions
9960 Mayland Dr., Suite 300
Richmond, VA 23230
Phone (804) 367-4600
Fax (804) 527-4429