ROBERT EDWARD STALLWORTH MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036059291

License Status

NOT RENEWED

Business

First Name

ROBERT EDWARD

Last Name

STALLWORTH

Suffix

Business Name

ROBERT EDWARD STALLWORTH MD

Original Issue Date

08/27/1979

Effective Date

06/27/2011

Expiration Date

07/31/2014

City

SPRINGFIELD

State

Zip

62781

County

SANGAMON

Ever Disciplined

LastModifiedDate

11/17/2014