THEODORE SCOTT DERSE MD - Medical Doctor License in Wisconsin | # 036139601

THEODORE SCOTT DERSE MD

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036139601

License Status

NOT RENEWED

Business

N

Title

MD

First Name

THEODORE

Middle

SCOTT

Last Name

DERSE

Business Name

THEODORE SCOTT DERSE MD

Original Issue Date

01/13/2016

Effective Date

05/04/2017

Expiration Date

09/30/2020

State

WI

Ever Disciplined

N

LastModifiedDate

01/14/2021