ROGER ADOLPH EWALD MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036043360

License Status

NOT RENEWED

Business

First Name

ROGER ADOLPH

Last Name

EWALD

Suffix

Business Name

ROGER ADOLPH EWALD MD

Original Issue Date

06/30/1970

Effective Date

04/21/2014

Expiration Date

07/31/2017

City

MONTICELLO

State

Zip

61856

County

PIATT

Ever Disciplined

LastModifiedDate

11/01/2017