WALTER CLARK BOUTWELL MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036103491

License Status

NOT RENEWED

Business

First Name

WALTER

Middle

CLARK

Last Name

BOUTWELL

Suffix

Business Name

WALTER CLARK BOUTWELL MD

Original Issue Date

09/18/2000

Effective Date

08/19/2020

Expiration Date

07/31/2023

City

PIKE ROAD

State

Zip

36064

County

JACKSON

Ever Disciplined

LastModifiedDate

11/30/2023